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Perceptions on basilar artery occlusion management in China versus other countries: Analysis of the after the BEST of BASICS (ABBA) survey
X. Huo, P. Klein, . Raynald, B. Drumm, Y. Chen, MM. Qureshi, WJ. Schonewille, X. Liu, W. Hu, X. Ji, C. Li, Y. Zhu, M. Abdalkader, D. Strbian, U. Fischer, V. Puetz, F. Alemseged, H. Yamagami, S. Sacco, G. Saposnik, P. Michel, ES. Kristoffersen, P....
Language English Country United States
Document type Journal Article
- MeSH
- Basilar Artery * surgery MeSH
- Arterial Occlusive Diseases * therapy MeSH
- Stroke therapy MeSH
- Endovascular Procedures * methods MeSH
- Humans MeSH
- Surveys and Questionnaires MeSH
- Randomized Controlled Trials as Topic MeSH
- Retrospective Studies MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
INTRODUCTION: Uncertainty remains on the optimal management of basilar artery occlusion (BAO). Two large randomized controlled trials (RCTs) in 2019 and 2021 demonstrated neutral results with respect to the use of endovascular therapy (EVT) for BAO. This study aimed to understand regional variation in physicians' perceptions towards the treatment of BAO as stratified by physician respondents from China versus outside China, prior to the publication of studies demonstrating a benefit of EVT for BAO. METHODS: An international online survey was conducted of stroke neurologists and neurointerventionalists from January to March 2022. Survey questions evaluated physician opinions toward the use of EVT in BAO, as well as the clinical and imaging features underlying treatment decisions. Respondents were dichotomized as either from China or from other countries and differences between groups were analyzed. RESULTS: There were 1245 physician respondents across 73 countries of which 295 (23.7%) were from China. Compared to respondents from the rest of the world, respondents from China were more likely to be interventionalists (71.5% vs 35.0%; p < 0.0001). Overall, more than 95% of respondents believed that EVT was superior to medical therapy under certain circumstances. Chinese respondents were more likely to believe that further RCTs were necessary than respondents from other countries (93.6% vs 76.2%; p < 0.0001). Chinese respondents were more likely to use advanced imaging in later time windows and use a premorbid mRS threshold of ≤2 for BAO selection to EVT. CONCLUSION: Most stroke physicians believe EVT is beneficial in selected patients with BAO. Clinical and imaging modality differences were observed in the selection criteria used for EVT. There was greater inclination to enroll all trial eligible patients in a BAO RCT by respondents from China as compared to other parts of the world.
Cooper Neurological Institute Cooper University Hospital Camden NJ USA
Department fo Neurology Bern University Hospital University of Bern Switzerland
Department of Biotechnological and Applied Clinical Sciences University of L'Aquila Italy
Department of Emergency Xiangtan Central Hospital Xiangtan China
Department of Neurology Akershus University Hospital Lørenskog Norway
Department of Neurology Basel University Hospital University of Basel Switzerland
Department of Neurology General Hospital of Northern Theater Command Shen Yang China
Department of Neurology Heidelberg University Hospital Heidelberg Germany
Department of Neurology Helsinki University Hospital and Helsinki University Helsinki Finland
Department of Neurology Klinikum Ludwigshafen Ludwigshafen Germany
Department of Neurology Linyi People's Hospital Linyi China
Department of Neurology Xuanwu Hospital Capital Medical University Beijing China
Department of Neurosurgery Xuanwu Hospital Capital Medical University Beijing China
Hospital de Clínicas de Porto Alegre Brazil
Interventional Neuroradiology Beijing Tiantan Hospital Beijing China
Neurology Boston Medical Center Boston University Chobanian and Avedisian School of Medicine MA
Neurology Federal University of Rio Grande do Sul Porto Alegre
Neurology Foshan Sanshui District People's Hospital Foshan China
Neurology Jinling Hospital Medical School of Nanjing University Nanjing China
Neurology Leuven University Hospital Leuven Belgium
Neurology St Antonius Hospital Nieuwegein the Netherlands
Neurology University of Pittsburgh Medical Center USA
Neuroradiologie Interventionelle Centre Hospitalier de l'Universite de Montreal Montreal Canada
Radiation Oncology Boston Medical Center MA USA
Radiology Boston Medical Center Boston University School of Medicine Boston MA USA
Radiology Imperial College Healthcare NHS Trust Charing Cross Hospital London UK
Stroke Center Bach Mai Hospital Hanoi Medical University Hanoi Vietnam
Stroke Medicine Imperial College Healthcare NHS Trust Charing Cross Hospital London UK
Stroke Neurology National Hospital Organization Osaka National Hospital Osaka Japan
Universitätsklinikum Hamburg Eppendorf Klinik und Poliklinik für Neurologie Hamburg Germany
Vietnam National University of Medicine and Pharmacy Vietnam
Xinqiao Hospital and The 2nd Affiliated Hospital Army Medical University
References provided by Crossref.org
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- $a INTRODUCTION: Uncertainty remains on the optimal management of basilar artery occlusion (BAO). Two large randomized controlled trials (RCTs) in 2019 and 2021 demonstrated neutral results with respect to the use of endovascular therapy (EVT) for BAO. This study aimed to understand regional variation in physicians' perceptions towards the treatment of BAO as stratified by physician respondents from China versus outside China, prior to the publication of studies demonstrating a benefit of EVT for BAO. METHODS: An international online survey was conducted of stroke neurologists and neurointerventionalists from January to March 2022. Survey questions evaluated physician opinions toward the use of EVT in BAO, as well as the clinical and imaging features underlying treatment decisions. Respondents were dichotomized as either from China or from other countries and differences between groups were analyzed. RESULTS: There were 1245 physician respondents across 73 countries of which 295 (23.7%) were from China. Compared to respondents from the rest of the world, respondents from China were more likely to be interventionalists (71.5% vs 35.0%; p < 0.0001). Overall, more than 95% of respondents believed that EVT was superior to medical therapy under certain circumstances. Chinese respondents were more likely to believe that further RCTs were necessary than respondents from other countries (93.6% vs 76.2%; p < 0.0001). Chinese respondents were more likely to use advanced imaging in later time windows and use a premorbid mRS threshold of ≤2 for BAO selection to EVT. CONCLUSION: Most stroke physicians believe EVT is beneficial in selected patients with BAO. Clinical and imaging modality differences were observed in the selection criteria used for EVT. There was greater inclination to enroll all trial eligible patients in a BAO RCT by respondents from China as compared to other parts of the world.
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