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Basilar artery occlusion management: Specialist perspectives from an international survey.
Edwards, Christopher; Drumm, Brian; Siegler, James E; Schonewille, Wouter J; Klein, Piers; Huo, Xiaochuan; Chen, Yimin; Abdalkader, Mohamad; Qureshi, Muhammad M; Strbian, Daniel; Liu, Xinfeng; Hu, Wei; Ji, Xunming; Li, Chuanhui; Fischer, Urs; Nagel, Simon; Puetz, Volker; Michel, Patrik; Alemseged, Fana; Sacco, Simona; Yamagami, Hiroshi; Yaghi, Shadi; Strambo, Davide; Kristoffersen, Espen Saxhaug; Sandset, Else C; Mikulik, Robert; Tsivgoulis, Georgios; Masoud, Hesham E; de Sousa, Diana Aguiar; Marto, João Pedro; Lobotesis, Kyriakos; Roi, Dylan; Berberich, Anne; Demeestere, Jelle; Meinel, Thomas R; Rivera, Rodrigo; Poli, Sven; Ton, Mai Duy; Zhu, Yuyou; Li, Fengli; Sang, Hongfei; Thomalla, Götz; Parsons, Mark; Campbell, Bruce C V; Zaidat, Osama O; Chen, Hui-Sheng; Field, Thalia S; Raymond, Jean; Kaesmacher, Johannes; Nogueira, Raul G.
Afiliação
  • Edwards C; Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA.
  • Drumm B; Department of Stroke Medicine, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.
  • Siegler JE; Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA.
  • Schonewille WJ; Department of Neurology, St. Antonius Hospital, Nieuwegein, The Netherlands.
  • Klein P; Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA.
  • Huo X; Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
  • Chen Y; Department of Neurology, Foshan Sanshui District People's Hospital, Foshan, China.
  • Abdalkader M; Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA.
  • Qureshi MM; Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA.
  • Strbian D; Radiation Oncology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA.
  • Liu X; Department of Neurology, Helsinki University Hospital, Helsinki, Finland.
  • Hu W; Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
  • Ji X; Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
  • Li C; Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
  • Fischer U; Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
  • Nagel S; Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
  • Puetz V; Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland.
  • Michel P; Department of Neurology, Basel University Hospital, University of Basel, Basel, Switzerland.
  • Alemseged F; Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen am Rhein, Germany.
  • Sacco S; Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
  • Yamagami H; Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
  • Yaghi S; Dresden Neurovascular Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
  • Strambo D; Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
  • Kristoffersen ES; Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.
  • Sandset EC; Neuroscience Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
  • Mikulik R; Department of Stroke Neurology, National Hospital Organization, Osaka National Hospital, Osaka, Japan.
  • Tsivgoulis G; Department of Neurology, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA.
  • Masoud HE; Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
  • de Sousa DA; Department of Neurology, Akershus University Hospital, Lørenskog, Norway.
  • Marto JP; Department of General Practice, University of Oslo, Oslo, Norway.
  • Lobotesis K; Department of Neurology, The Norwegian Air Ambulance Foundation, Oslo, Norway.
  • Roi D; Department of Neurology, International Clinical Research Center, St Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
  • Berberich A; Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
  • Demeestere J; Department of Neurology, State University of New York, Upstate Medical University, Syracuse, New York, USA.
  • Meinel TR; Lisbon Central University Hospital and Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.
  • Rivera R; Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
  • Poli S; Department of Radiology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.
  • Ton MD; Department of Radiology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.
  • Zhu Y; Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen am Rhein, Germany.
  • Li F; Neurology Department, Leuven University Hospital, Leuven, Belgium.
  • Sang H; Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland.
  • Thomalla G; Neuroradiology Department, Instituto de Neurocirugia Dr. Asenjo, Santiago, Chile.
  • Parsons M; Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tübingen, Germany.
  • Campbell BCV; Department of Neurology & Stroke, Eberhard-Karls University, Tübingen, Germany.
  • Zaidat OO; Stroke Center, Bach Mai Hospital, Hanoi, Vietnam.
  • Chen HS; Hanoi Medical University, Hanoi, Vietnam.
  • Field TS; Vietnam National University of Medicine and Pharmacy, Hanoi, Vietnam.
  • Raymond J; Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
  • Kaesmacher J; Department of Neurology, Xinqiao Hospital of the Army Medical University, Chongqing, China.
  • Nogueira RG; Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
J Neuroimaging ; 33(3): 422-433, 2023.
Article em En | MEDLINE | ID: mdl-36781295
ABSTRACT
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.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Arteriopatias Oclusivas / Acidente Vascular Cerebral / Procedimentos Endovasculares Tipo de estudo: Clinical_trials / Observational_studies Limite: Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Arteriopatias Oclusivas / Acidente Vascular Cerebral / Procedimentos Endovasculares Tipo de estudo: Clinical_trials / Observational_studies Limite: Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article