• Christopher Edwards, Brian Drumm, James E Siegler, Wouter J Schonewille, Piers Klein, Xiaochuan Huo, Yimin Chen, Mohamad Abdalkader, Muhammad M Qureshi, Daniel Strbian, Xinfeng Liu, Wei Hu, Xunming Ji, Chuanhui Li, Urs Fischer, Simon Nagel, Volker Puetz, Patrik Michel, Fana Alemseged, Simona Sacco, Hiroshi Yamagami, Shadi Yaghi, Davide Strambo, Espen Saxhaug Kristoffersen, Else C Sandset, Robert Mikulik, Georgios Tsivgoulis, Hesham E Masoud, de SousaDiana AguiarDA0000-0002-6702-7924Lisbon Central University Hospital and Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal., João Pedro Marto, Kyriakos Lobotesis, Dylan Roi, Anne Berberich, Jelle Demeestere, Thomas R Meinel, Rodrigo Rivera, Sven Poli, Mai Duy Ton, Yuyou Zhu, Fengli Li, Hongfei Sang, Götz Thomalla, Mark Parsons, CampbellBruce C VBCV0000-0003-3632-9433Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia., Osama O Zaidat, Hui-Sheng Chen, Thalia S Field, Jean Raymond, Johannes Kaesmacher, Raul G Nogueira, Tudor G Jovin, Dapeng Sun, Raynald Liu, Adnan I Qureshi, Zhongming Qiu, Zhongrong Miao, Soma Banerjee, and Thanh N Nguyen.
• Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA.
• J Neuroimaging. 2023 May 1; 33 (3): 422433422-433.

Background And PurposeTwo early basilar artery occlusion (BAO) randomized controlled trials did not establish the superiority of endovascular thrombectomy (EVT) over medical management. While many providers continue to recommend EVT for acute BAO, perceptions of equipoise in randomizing patients with BAO to EVT versus medical management may differ between clinician specialties.MethodsWe conducted an international survey (January 18, 2022 to March 31, 2022) regarding management strategies in acute BAO prior to the announcement of two trials indicating the superiority of EVT, and compared responses between interventionalists (INTs) and non-interventionalists (nINTs). Selection practices for routine EVT and perceptions of equipoise regarding randomizing to medical management based on neuroimaging and clinical features were compared between the two groups using descriptive statistics.ResultsAmong the 1245 respondents (nINTs = 702), INTs more commonly believed that EVT was superior to medical management in acute BAO (98.5% vs. 95.1%, p < .01). A similar proportion of INTs and nINTs responded that they would not randomize a patient with BAO to EVT (29.4% vs. 26.7%), or that they would only under specific clinical circumstances (p = .45). Among respondents who would recommend EVT for BAO, there was no difference in the maximum prestroke disability, minimum stroke severity, or infarct burden on computed tomography between the two groups (p > .05), although nINTs more commonly preferred perfusion imaging (24.2% vs. 19.7%, p = .04). Among respondents who indicated they would randomize to medical management, INTs were more likely to randomize when the National Institutes of Health Stroke Scale was ≥10 (15.9% vs. 6.9%, p < .01).ConclusionsFollowing the publication of two neutral clinical trials in BAO EVT, most stroke providers believed EVT to be superior to medical management in carefully selected patients, with most indicating they would not randomize a BAO patient to medical treatment. There were small differences in preference for advanced neuroimaging for patient selection, although these preferences were unsupported by clinical trial data at the time of the survey.© 2023 American Society of Neuroimaging.

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