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.

2nd Department of Neurology Attikon University Hospital National and Kapodistrian University of Athens Athens Greece

Cooper Neurological Institute Cooper University Hospital Camden NJ USA

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 fo Neurology Bern University Hospital University of Bern Switzerland

Department of Neurology Dresden Neurovascular Center Universitätsklinik Carl Gustav Carus Technische Universität Dresden Dresden Germany

Department of Neurology General Hospital of Northern Theater Command Shen Yang China

Department of Neurology Heidelberg University Hospital Heidelberg Germany; Department of Neurology Klinikum Ludwigshafen Ludwigshafen Germany

Department of Neurology Helsinki University Hospital and Helsinki University Helsinki Finland

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

International Clinical Research Center and Department of Neurology St Anne's University Hospital and Faculty of Medicine Masaryk University Brno Czech Republic

International Clinical Research Center and Department of Neurology St Anne's University Hospital and Faculty of Medicine Masaryk University Brno Czech Republic; Department of Internal Medicine and Cardiology University Hospital Brno and Faculty of Medicine Masaryk University Brno Czech Republic

Interventional Neuroradiology Beijing Tiantan Hospital Beijing China

Medicine and Neurology Melbourne Brain Centre at the Royal Melbourne Hospital University of Melbourne Parkville Victoria Australia

Neurology Federal University of Rio Grande do Sul Porto Alegre; Hospital de Clínicas de Porto Alegre Brazil

Neurology Foshan Sanshui District People's Hospital Foshan China

Neurology Jinling Hospital Medical School of Nanjing University Nanjing China; Stroke Center and Department of Neurology The 1st Affiliated Hospital of the University of Science and Technology of China Division of Life Sciences and Medicine University of Science and Technology of China Hefei Anhui China

Neurology Leuven University Hospital Leuven Belgium

Neurology Service Clinical Neurosciences Lausanne University Hospital and University of Lausanne Lausanne Switzerland

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

Radiology Boston Medical Center Boston University School of Medicine Boston MA USA

Radiology Boston Medical Center Boston University School of Medicine Boston MA USA; Neurology Boston Medical Center Boston University Chobanian and Avedisian School of Medicine MA

Radiology Boston Medical Center Boston University School of Medicine Boston MA USA; Radiation Oncology Boston Medical Center MA USA

Radiology Imperial College Healthcare NHS Trust Charing Cross Hospital London UK

Stroke Center and Department of Neurology The 1st Affiliated Hospital of the University of Science and Technology of China Division of Life Sciences and Medicine University of Science and Technology of China Hefei Anhui China

Stroke Center Bach Mai Hospital Hanoi Medical University Hanoi Vietnam; Vietnam National University of Medicine and Pharmacy Vietnam

Stroke Medicine Imperial College Healthcare NHS Trust Charing Cross Hospital London UK

Stroke Neurology National Hospital Organization Osaka National Hospital Osaka Japan

Stroke Outcomes and Decision Neuroscience Research Unit Division of Neurology University of Toronto Toronto Canada

Universitätsklinikum Hamburg Eppendorf Klinik und Poliklinik für Neurologie Hamburg Germany

Xinqiao Hospital and The 2nd Affiliated Hospital Army Medical University

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