Basilar artery occlusion management: an international survey of middle versus high-income countries

Brian Drumm*, Ana Herning, Piers Klein, Jean Raymond, Mohamad Abdalkader, Xiaochuan Huo, Yimin Chen, James E. Siegler, Meabh Peacock, Wouter J. Schonewille, Xinfeng Liu, Wei Hu, Xunming Ji, Chuanhui Li, Fana Alemseged, Liping Liu, Simon Nagel, Daniel Strbian, Leticia C. Rebello, Shadi YaghiMuhammad M. Qureshi, Urs Fischer, Georgios Tsivgoulis, Johannes Kaesmacher, Hiroshi Yamagami, Volker Puetz, P. N. Sylaja, João Pedro Marto, Simona Sacco, Espen Saxhaug Kristoffersen, Jelle Demeestere, Adriana B. Conforto, Lukas Meyer, Daniel P.O. Kaiser, Tilman Reiff, Kubilay Aydin, Michele Romoli, Francesco Diana, Kyriakos Lobotesis, Dylan Roi, Hesham E. Masoud, Alice Ma, Mahmoud H. Mohammaden, Mohamed F. Doheim, Yuyou Zhu, Hongfei Sang, Dapeng Sun, Mai Duy Ton, Raynald, Fengli Li, Bertrand Lapergue, Uta Hanning, Qingwu Yang, Jin Soo Lee, Götz Thomalla, Pengfei Yang, Jianmin Liu, Bruce C.V. Campbell, Hui Sheng Chen, Osama O. Zaidat, Zhongming Qiu, Raul G. Nogueira, Zhongrong Miao, Thanh N. Nguyen*, Soma Banerjee

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)

Abstract

Background and Purpose: Two early basilar artery occlusion (BAO) randomized controlled trials (RCTs) did not establish the superiority of endovascular thrombectomy (EVT) over medical management. Yet many providers continued to recommend EVT. The goal of the present article is to compare physicians’ diagnostic and management strategies of BAO among middle-income and high-income countries (MICs and HICs, respectively). Methods: We conducted an international survey from January to March 2022 regarding management strategies in acute BAO, to examine clinical and imaging parameters influencing clinician management of patients with BAO. We compared responses between physicians from HIC and MIC. Results: Among the 1245 respondents from 73 countries, 799 (64.2%) were from HIC, with the remaining 393 (31.6%) from MIC. Most respondents perceived that EVT was superior to medical management for acute BAO, but more so in respondents from HIC (98.0% vs. 94.2%, p < 0.01). MIC respondents were more likely to believe further RCTs were warranted (91.6% vs. 74.0%, p < 0.01) and were more likely to find it acceptable to enroll any patient who met a trial’s criteria in the standard medical treatment arm (58.8% vs. 38.5%, p < 0.01). Conclusions: In an area where clinical equipoise was called into question despite the lack of RCT evidence, we found that respondents from MIC were more likely to express willingness to enroll patients with BAO in an RCT than their HIC counterparts.

Original languageEnglish
Pages (from-to)702-711
Number of pages10
JournalInterventional Neuroradiology
Volume30
Issue number5
DOIs
Publication statusPublished - Oct 2024
Externally publishedYes

Keywords

  • Basilar artery occlusion
  • High-income country
  • Intravenous thrombolysis
  • Mechanical thrombectomy
  • Middle-income country

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