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.

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

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 Interventional Neuroradiology Beijing Tiantan Hospital Capital Medical University Beijing China

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

Department of Medicine Division of Neurology University of British Columbia Vancouver British Columbia Canada

Department of Neurology Affiliated Hangzhou 1st People's Hospital Zhejiang University School of Medicine Hangzhou China

Department of Neurology Affiliated Jinling Hospital Medical School of Nanjing University Nanjing China

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

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 State University of New York Upstate Medical University Syracuse New York USA

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 Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany

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

Dresden Neurovascular Center University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany

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

Lisbon Central University Hospital and Faculdade de Medicina da Universidade de Lisboa Lisbon Portugal

Neurology Department Leuven University Hospital Leuven Belgium

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

Neuroradiologie Interventionelle Centre Hospitalier de l'Universite de Montreal Montreal Quebec Canada

Neuroradiology Department Instituto de Neurocirugia Dr Asenjo Santiago Chile

Neuroscience and Stroke Program Bon Secours Mercy Health St Vincent Hospital Toledo Ohio USA

Neuroscience Section Department of Biotechnological and Applied Clinical Sciences University of L'Aquila L'Aquila Italy

Radiation Oncology Boston Medical Center Boston University Chobanian and Avedisian School of Medicine Boston Massachusetts USA

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

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

Zeenat Qureshi Stroke Institute and Department of Neurology University of Missouri Columbia Missouri USA

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Specialist Perspectives on the Imaging Selection of Large Vessel Occlusion in the Late Window