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Basilar artery occlusion management: Specialist perspectives from an international survey
C. Edwards, B. Drumm, JE. Siegler, WJ. Schonewille, P. Klein, X. Huo, Y. Chen, M. Abdalkader, MM. Qureshi, D. Strbian, X. Liu, W. Hu, X. Ji, C. Li, U. Fischer, S. Nagel, V. Puetz, P. Michel, F. Alemseged, S. Sacco, H. Yamagami, S. Yaghi, D....
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články
PubMed
36781295
DOI
10.1111/jon.13084
Knihovny.cz E-zdroje
- MeSH
- arteria basilaris diagnostické zobrazování MeSH
- arteriální okluzní nemoci * MeSH
- cévní mozková příhoda * terapie MeSH
- endovaskulární výkony * metody MeSH
- lidé MeSH
- retrospektivní studie MeSH
- trombektomie metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND AND PURPOSE: Two 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. METHODS: We 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. RESULTS: Among 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). CONCLUSIONS: Following 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.
Cooper Neurological Institute Cooper University Hospital Camden New Jersey USA
Department of Diagnostic and Interventional Neuroradiology University Hospital Bern Bern Switzerland
Department of General Practice University of Oslo Oslo Norway
Department of Neurology Akershus University Hospital Lørenskog Norway
Department of Neurology and Stroke Eberhard Karls University Tübingen Germany
Department of Neurology Basel University Hospital University of Basel Basel Switzerland
Department of Neurology Bern University Hospital University of Bern Bern Switzerland
Department of Neurology Boston Medical Center Boston Massachusetts USA
Department of Neurology Foshan Sanshui District People's Hospital Foshan China
Department of Neurology General Hospital of Northern Theatre Command Shenyang China
Department of Neurology Heidelberg University Hospital Heidelberg Germany
Department of Neurology Helsinki University Hospital Helsinki Finland
Department of Neurology Hospital de Egas Moniz Centro Hospitalar Lisboa Ocidental Lisbon Portugal
Department of Neurology Klinikum Ludwigshafen Ludwigshafen am Rhein Germany
Department of Neurology Rhode Island Hospital Brown University Providence Rhode Island USA
Department of Neurology St Antonius Hospital Nieuwegein The Netherlands
Department of Neurology The 903rd Hospital of The Chinese People's Liberation Army Hangzhou China
Department of Neurology The Norwegian Air Ambulance Foundation Oslo Norway
Department of Neurology University of Pittsburgh Medical Center Pittsburgh Pennsylvania USA
Department of Neurology Xinqiao Hospital of the Army Medical University Chongqing China
Department of Neurology Xuanwu Hospital Capital Medical University Beijing China
Department of Neurosurgery Xuanwu Hospital Capital Medical University Beijing China
Department of Radiology Boston Medical Center Boston Massachusetts USA
Department of Radiology Imperial College Healthcare NHS Trust Charing Cross Hospital London UK
Department of Stroke Medicine Imperial College Healthcare NHS Trust Charing Cross Hospital London UK
Department of Stroke Neurology National Hospital Organization Osaka National Hospital Osaka Japan
Hanoi Medical University Hanoi Vietnam
Hertie Institute for Clinical Brain Research Eberhard Karls University Tübingen Germany
Klinik und Poliklinik für Neurologie Universitätsklinikum Hamburg Eppendorf Hamburg Germany
Neurology Department Leuven University Hospital Leuven Belgium
Neuroradiology Department Instituto de Neurocirugia Dr Asenjo Santiago Chile
Neuroscience and Stroke Program Bon Secours Mercy Health St Vincent Hospital Toledo Ohio USA
Stroke Center Bach Mai Hospital Hanoi Vietnam
Sydney Brain Center University of New South Wales Sydney New South Wales Australia
Vietnam National University of Medicine and Pharmacy Hanoi Vietnam
Citace poskytuje Crossref.org
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