Basilar artery occlusion management: Specialist perspectives
from an international survey

J 2023

Basilar artery occlusion management: Specialist perspectives from an international survey

EDWARDS, Christopher, Brian DRUMM, James E SIEGLER, Wouter J SCHONEWILLE, Piers KLEIN et. al.

Basic information

Original name

Basilar artery occlusion management: Specialist perspectives from an international survey

Authors

EDWARDS, Christopher, 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 MIKULÍK (203 Czech Republic, belonging to the institution), Georgios TSIVGOULIS, Hesham E MASOUD, de Sousa Diana AGUIAR, Joao 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, Goetz THOMALLA, Mark PARSONS, Bruce C V CAMPBELL, 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 (guarantor)

Edition

Journal of Neuroimaging, Hoboken, Wiley-Blackwell, 2023, 1051-2284

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30210 Clinical neurology

Country of publisher

United States of America

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 2.400 in 2022

RIV identification code

RIV/00216224:14110/23:00130696

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1111/jon.13084

UT WoS

000940458800001

Keywords in English

basilar artery occlusion; endovascular therapy; intravenous thrombolysis; mechanical thrombectomy

Abstract

V originále

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.

Citovat

EDWARDS, Christopher, 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 MIKULÍK, Georgios TSIVGOULIS, Hesham E MASOUD, de Sousa Diana AGUIAR, Joao 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, Goetz THOMALLA, Mark PARSONS, Bruce C V CAMPBELL, 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. Basilar artery occlusion management: Specialist perspectives from an international survey. Journal of Neuroimaging. Hoboken: Wiley-Blackwell, 2023, vol. 33, No 3, p. 422-433. ISSN 1051-2284. Available from: https://dx.doi.org/10.1111/jon.13084.

@article{2279452,
   author = {Edwards, Christopher and Drumm, Brian and Siegler, James E and Schonewille, Wouter J and Klein, Piers and Huo, Xiaochuan and Chen, Yimin and Abdalkader, Mohamad and Qureshi, Muhammad M and Strbian, Daniel and Liu, Xinfeng and Hu, Wei and Ji, Xunming and Li, Chuanhui and Fischer, Urs and Nagel, Simon and Puetz, Volker and Michel, Patrik and Alemseged, Fana and Sacco, Simona and Yamagami, Hiroshi and Yaghi, Shadi and Strambo, Davide and Kristoffersen, Espen Saxhaug and Sandset, Else C and Mikulík, Robert and Tsivgoulis, Georgios and Masoud, Hesham E and Aguiar, de Sousa Diana and Marto, Joao Pedro and Lobotesis, Kyriakos and Roi, Dylan and Berberich, Anne and Demeestere, Jelle and Meinel, Thomas R and Rivera, Rodrigo and Poli, Sven and Ton, Mai Duy and Zhu, Yuyou and Li, Fengli and Sang, Hongfei and Thomalla, Goetz and Parsons, Mark and Campbell, Bruce C V and Zaidat, Osama O and Chen, HuiandSheng and Field, Thalia S and Raymond, Jean and Kaesmacher, Johannes and Nogueira, Raul G and Jovin, Tudor G and Sun, Dapeng and Liu, Raynald and Qureshi, Adnan I and Qiu, Zhongming and Miao, Zhongrong and Banerjee, Soma and Nguyen, Thanh N},
   article_location = {Hoboken},
   article_number = {3},
   doi = {http://dx.doi.org/10.1111/jon.13084},
   keywords = {basilar artery occlusion; endovascular therapy; intravenous thrombolysis; mechanical thrombectomy},
   language = {eng},
   issn = {1051-2284},
   journal = {Journal of Neuroimaging},
   title = {Basilar artery occlusion management: Specialist perspectives from an international survey},
   url = {https://onlinelibrary.wiley.com/doi/10.1111/jon.13084},
   volume = {33},
   year = {2023}
}

TY  - JOUR
ID  - 2279452
AU  - Edwards, Christopher - Drumm, Brian - Siegler, James E - Schonewille, Wouter J - Klein, Piers - Huo, Xiaochuan - Chen, Yimin - Abdalkader, Mohamad - Qureshi, Muhammad M - Strbian, Daniel - Liu, Xinfeng - Hu, Wei - Ji, Xunming - Li, Chuanhui - Fischer, Urs - Nagel, Simon - Puetz, Volker - Michel, Patrik - Alemseged, Fana - Sacco, Simona - Yamagami, Hiroshi - Yaghi, Shadi - Strambo, Davide - Kristoffersen, Espen Saxhaug - Sandset, Else C - Mikulík, Robert - Tsivgoulis, Georgios - Masoud, Hesham E - Aguiar, de Sousa Diana - Marto, Joao Pedro - Lobotesis, Kyriakos - Roi, Dylan - Berberich, Anne - Demeestere, Jelle - Meinel, Thomas R - Rivera, Rodrigo - Poli, Sven - Ton, Mai Duy - Zhu, Yuyou - Li, Fengli - Sang, Hongfei - Thomalla, Goetz - Parsons, Mark - Campbell, Bruce C V - Zaidat, Osama O - Chen, Hui-Sheng - Field, Thalia S - Raymond, Jean - Kaesmacher, Johannes - Nogueira, Raul G - Jovin, Tudor G - Sun, Dapeng - Liu, Raynald - Qureshi, Adnan I - Qiu, Zhongming - Miao, Zhongrong - Banerjee, Soma - Nguyen, Thanh N
PY  - 2023
TI  - Basilar artery occlusion management: Specialist perspectives from an international survey
JF  - Journal of Neuroimaging
VL  - 33
IS  - 3
SP  - 422-433
EP  - 422-433
PB  - Wiley-Blackwell
SN  - 10512284
KW  - basilar artery occlusion
KW  - endovascular therapy
KW  - intravenous thrombolysis
KW  - mechanical thrombectomy
UR  - https://onlinelibrary.wiley.com/doi/10.1111/jon.13084
N2  - 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.
ER  -

EDWARDS, Christopher, 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 MIKULÍK, Georgios TSIVGOULIS, Hesham E MASOUD, de Sousa Diana AGUIAR, Joao 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, Goetz THOMALLA, Mark PARSONS, Bruce C V CAMPBELL, 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. Basilar artery occlusion management: Specialist perspectives from an international survey. \textit{Journal of Neuroimaging}. Hoboken: Wiley-Blackwell, 2023, vol.~33, No~3, p.~422-433. ISSN~1051-2284. Available from: https://dx.doi.org/10.1111/jon.13084.

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