Stroke: Vascular and Interventional Neurology (Mar 2023)

Abstract Number ‐ 6: Basilar Artery Occlusion Thrombectomy Technique: An International Survey of Practice Patterns

  • Piers Klein,
  • Ana Herning,
  • Brian Drumm,
  • Jean Raymond,
  • Mohamad Abdalkader,
  • Anurag Sahoo,
  • James E Siegler,
  • Yimin Chen,
  • Xiaochuan Huo,
  • Wouter J Schonewille,
  • Xinfeng Liu,
  • Wei Hu,
  • Xunming Ji,
  • Bertrand Lapergue,
  • Chuanhui Li,
  • Fana Alemseged,
  • Daniel Strbian,
  • Urs Fischer,
  • Johannes Kaesmacher,
  • Hiroshi Yamagami,
  • Volker Puetz,
  • Simona Sacco,
  • Espen Saxhaug Kristoffersen,
  • Jelle Demeestere,
  • Kyriakos Lobotesis,
  • Kubilay Aydin,
  • Francesco Diana,
  • Hesham E Masoud,
  • Alice Ma,
  • Roberta Novakovic‐White,
  • Fawaz Al‐Mufti,
  • Mai Duy Ton,
  • Jean Christophe Gentric,
  • Jildaz Caroff,
  • Marios‐Nikos Psychogios,
  • Lukas Meyer,
  • Jens Fiehler,
  • Joey English,
  • Rishi Gupta,
  • Bernard Yan,
  • Bruce Campbell,
  • Ashutosh P Jadhav,
  • Jin Soo Lee,
  • Götz Thomalla,
  • Simon Nagel,
  • Osama O Zaidat,
  • Zhongming Qiu,
  • Zhongrong Miao,
  • Soma Banerjee,
  • Thanh N Nguyen

DOI
https://doi.org/10.1161/SVIN.03.suppl_1.006
Journal volume & issue
Vol. 3, no. S1

Abstract

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Introduction Two recent trials demonstrated a benefit for endovascular thrombectomy (EVT) in the treatment of basilar artery occlusion (BAO). Considering the expected increase in the utilization of EVT for BAO, we sought to understand the technique preferences of neurointerventionalists currently performing EVT for BAO. Methods We conducted an international online survey of physician opinions on the use of EVT in BAO between January to March 2022. The survey was distributed through stroke and neurointerventional organizations. Survey questions examined selection of patients for the procedure and the techniques currently used for EVT in BAO. Results More than 3,000 participants were invited yielding 1,245 respondents, of which 543 were classified as neurointerventionalists across 52 countries and included in this analysis. Most neurointerventionalists would proceed to EVT for occlusions of the V4 segment, the basilar artery, or the PCA, without regard for prior IVT. For BAO of embolic etiology, aspiration only thrombectomy was the preferred method with 50.3% of neurointerventionalists. For BAO of intracranial atherosclerotic disease (ICAD) etiology, combined stent retriever and aspiration thrombectomy was the preferred method with 40.5% of neurointerventionalists (Figure 1). The majority of neurointerventionalists (88.0%) would proceed to stenting after three or fewer failed passes for patients with BAO of ICAD etiology. In patients undergoing stenting, aspirin and clopidogrel was the most common antiplatelet regime (52.4%). Conclusions Amongst the surveyed neurointerventionalists, the most common techniques for EVT of patients with BAO were contact aspiration or combined stent retriever with aspiration thrombectomy. For patients with BAO due to ICAD, the majority of neurointerventionalists were willing to stent and do so most often after three or fewer failed passes and with the use of dual antiplatelet medications. Further study is needed to determine the optimal technique for EVT of BAO with or without ICAD.