Stroke: Vascular and Interventional Neurology (Sep 2022)
Current Opinions on Optimal Management of Basilar Artery Occlusion: After the BEST of BASICS Survey
- Brian Drumm,
- Soma Banerjee,
- Muhammad M. Qureshi,
- Wouter J. Schonewille,
- Piers Klein,
- Xiaochuan Huo,
- Yimin Chen,
- Daniel Strbian,
- Urs Fischer,
- Volker Puetz,
- Wei Hu,
- Xunming Ji,
- Chuanhui Li,
- Fana Alemseged,
- Hiroshi Yamagami,
- Simona Sacco,
- Gustavo Saposnik,
- Patrik Michel,
- Espen Saxhaug Kristoffersen,
- Petra Sedova,
- Robert Mikulik,
- James E. Siegler,
- Thomas R. Meinel,
- Diana Aguiar de Sousa,
- Kyriakos Lobotesis,
- Dylan Roi,
- Jelle Demeestere,
- Kaiz S. Asif,
- Sheila O. Martins,
- Mohamad Abdalkader,
- Mayank Goyal,
- Thang Huy Nguyen,
- Mai Duy Ton,
- Yuyou Zhu,
- Xinfeng Liu,
- Zhongming Qiu,
- Zhongrong Miao,
- Jildaz Caroff,
- Michele Romoli,
- Francesco Diana,
- Götz Thomalla,
- Simon Nagel,
- Else C. Sandset,
- Bruce C.V. Campbell,
- Tudor G. Jovin,
- Raul G. Nogueira,
- Jean Raymond,
- Thanh N. Nguyen
Affiliations
- Brian Drumm
- Stroke Medicine Imperial College Healthcare NHS Trust, Charing Cross Hospital London UK
- Soma Banerjee
- Stroke Medicine Imperial College Healthcare NHS Trust, Charing Cross Hospital London UK
- Muhammad M. Qureshi
- Department of Radiology, Neurology Boston Medical Center Boston University School of Medicine Boston MA United States
- Wouter J. Schonewille
- Department of Neurology St. Antonius Hospital Nieuwegein The Netherlands
- Piers Klein
- Department of Radiology, Neurology Boston Medical Center Boston University School of Medicine Boston MA United States
- Xiaochuan Huo
- Interventional Neuroradiology Beijing Tiantan Hospital Beijing China
- Yimin Chen
- Department of Neurology Foshan Sanshui District People's Hospital Foshan Guangdong Province China
- Daniel Strbian
- Department of Neurology Helsinki University Hospital Helsinki Finland
- Urs Fischer
- Department of Neurology Stroke Research Center Bern Bern University Hospital University of Bern Bern Switzerland
- Volker Puetz
- Department of Neurology University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany
- Wei Hu
- The First Affiliated Hospital of USTC Division of Life Sciences and Medicine China
- Xunming Ji
- Xuanwu Hospital Beijing China
- Chuanhui Li
- Xuanwu Hospital Beijing China
- Fana Alemseged
- Medicine and Neurology Melbourne Brain Centre at the Royal Melbourne Hospital University of Melbourne Parkville Victoria Australia
- Hiroshi Yamagami
- Stroke Neurology National Hospital Organization Osaka National Hospital Osaka Japan
- Simona Sacco
- Neuroscience Section Department of Biotechnological and Applied Clinical Sciences University of L'Aquila L'Aquila AQ Italy
- Gustavo Saposnik
- Stroke Outcomes and Decision Neuroscience Research Unit Division of Neurology University of Toronto Toronto Canada
- Patrik Michel
- Neurology Service Clinical Neurosciences Lausanne University Hospital and University of Lausanne Lausanne Switzerland
- Espen Saxhaug Kristoffersen
- Department of Neurology Akershus University Hospital Lørenskog and Department of General Practice University of Oslo Oslo Norway
- Petra Sedova
- Department of Neurology International Clinical Research Center St. Anne's University Hospital and Faculty of Medicine Masaryk University Brno Czech Republic
- Robert Mikulik
- Department of Neurology International Clinical Research Center St. Anne's University Hospital and Faculty of Medicine Masaryk University Brno Czech Republic
- James E. Siegler
- Cooper Neurological Institute Cooper University Hospital Camden NJ United States
- Thomas R. Meinel
- Department of Neurology Stroke Research Center Bern Bern University Hospital University of Bern Bern Switzerland
- Diana Aguiar de Sousa
- Stroke Center Centro Hospitalar Universitário Lisboa Central – CHULC Portugal CEEM and Institute of Anatomy Faculdade de Medicina Universidade de Lisboa Lisbon Portugal
- Kyriakos Lobotesis
- Radiology Imperial College Healthcare NHS Trust Charing Cross Hospital London UK
- Dylan Roi
- Radiology Imperial College Healthcare NHS Trust Charing Cross Hospital London UK
- Jelle Demeestere
- Department of Neurology Leuven University Hospital Leuven Belgium
- Kaiz S. Asif
- Amita Health and University of Illinois‐Chicago Chicago IL United States
- Sheila O. Martins
- Neurology Federal University of Rio Grande do Sul Porto Alegre Hospital de Clínicas de Porto Alegre Porto Alegre Brazil
- Mohamad Abdalkader
- Department of Radiology, Neurology Boston Medical Center Boston University School of Medicine Boston MA United States
- Mayank Goyal
- Department of Radiology University of Calgary Alberta Canada
- Thang Huy Nguyen
- Cerebrovascular Disease 115 People Hospital Ho Chi Minh City Vietnam
- Mai Duy Ton
- Stroke Center Bach Mai Hospital Hanoi Medical University, Vietnam National University Hanoi Vietnam
- Yuyou Zhu
- The First Affiliated Hospital of USTC Division of Life Sciences and Medicine China
- Xinfeng Liu
- Stroke Center Neurology The First Affiliated Hospital of USTC Division of Life Sciences and Medicine University of Science and Technology of China Hefei China
- Zhongming Qiu
- Xinqiao Hospital and The Second Affiliated Hospital Army Medical University Chongqing China
- Zhongrong Miao
- Interventional Neuroradiology Beijing Tiantan Hospital Beijing China
- Jildaz Caroff
- Department of Interventional Neuroradiology NEURI Brain Vascular Center Bicêtre Hospital Assistance Publique Hôpitaux de Paris Le Kremlin‐Bicêtre France
- Michele Romoli
- Neurology and Stroke Unit Department of Neuroscience Bufalini Hospital Cesena Italy
- Francesco Diana
- Department of Neuroradiology University Hospital ‘San Giovanni di Dio e Ruggi d'Aragona’ Campania Italy
- Götz Thomalla
- Universitätsklinikum Hamburg‐Eppendorf Klinik und Poliklinik für Neurologie Hamburg Germany
- Simon Nagel
- Department of Neurology Heidelberg University Hospital Heidelberg Germany
- Else C. Sandset
- Department of Neurology Oslo University Hospital Oslo Norway
- Bruce C.V. Campbell
- Medicine and Neurology Melbourne Brain Centre at the Royal Melbourne Hospital University of Melbourne Parkville Victoria Australia
- Tudor G. Jovin
- Cooper Neurological Institute Cooper University Hospital Camden NJ United States
- Raul G. Nogueira
- Department of Neurology University of Pittsburgh Medical Center PA
- Jean Raymond
- Neuroradiologie Interventionelle Centre Hospitalier de l'Universite de Montreal Montreal Canada
- Thanh N. Nguyen
- Department of Radiology, Neurology Boston Medical Center Boston University School of Medicine Boston MA United States
- DOI
- https://doi.org/10.1161/SVIN.122.000538
- Journal volume & issue
-
Vol. 2,
no. 5
Abstract
Background The best management of basilar artery occlusion (BAO) remains uncertain. The BASICS (Basilar Artery International Cooperation Study) and the BEST (Basilar Artery Occlusion Endovascular Intervention Versus Standard Medical Treatment) trials reported neutral results. We sought to understand physicians’ approaches to BAOs and whether further BAO randomized controlled trials were warranted. Methods We conducted an online international survey from January to March 2022 to stroke neurologists and neurointerventionalists. Survey questions were designed to examine clinical and imaging parameters under which clinicians would offer (or rescind) a patient with BAO to endovascular therapy (EVT) or best medical management versus enrollment into a randomized clinical trial. Results Of >3002 invited participants, 1245 responded (41.4% response rate) from 73 countries, including 54.7% stroke neurologists and 43.6% neurointerventionalists. More than 95% of respondents would offer EVT to patients with BAO, albeit in various clinical circumstances. There were 70.0% of respondents who indicated that the BASICS and BEST trials did not change their practice. Only 22.1% of respondents would perform EVT according to anterior circulation occlusion criteria. The selection of patients for BAO EVT by clinical severity, timing, and imaging modality differed according to geography, specialty, and country income level. Over 80% of respondents agreed that further randomized clinical trials for BAO were warranted. Moreover, 45.6% of respondents indicated they would find it acceptable to enroll all trial‐eligible patients into the medical arm of a BAO trial, whereas 26.3% would not enroll. Conclusion Most stroke physicians continue to believe in the efficacy of EVT in selected patients with BAO in spite of BEST and BASICS. There is no consensus on which selection criteria to use, and few clinicians would use anterior circulation occlusion criteria for BAOs. Further randomized clinical trials for BAO are warranted.
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