Basilar artery occlusion management: An international survey of middle versus high-income countries.

Drumm, Brian; Herning, Ana; Klein, Piers; Raymond, Jean; Abdalkader, Mohamad; Huo, Xiaochuan; Chen, Yimin; Siegler, James E; Peacock, Meabh; Schonewille, Wouter J; Liu, Xinfeng; Hu, Wei; Ji, Xunming; Li, Chuanhui; Alemseged, Fana; Liu, Liping; Nagel, Simon; Strbian, Daniel; Rebello, Leticia C; Yaghi, Shadi; ... (2022). Basilar artery occlusion management: An international survey of middle versus high-income countries. (In Press). Interventional neuroradiology, p. 15910199221143190. Sage Publications 10.1177/15910199221143190

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Two early basilar artery occlusion (BAO) randomized controlled trials (RCTs) did not establish the superiority of endovascular thrombectomy (EVT) over medical management. Yet many providers continued to recommend EVT. The goal of the present article is to compare physicians' diagnostic and management strategies of BAO among middle-income and high-income countries (MICs and HICs, respectively).


We conducted an international survey from January to March 2022 regarding management strategies in acute BAO, to examine clinical and imaging parameters influencing clinician management of patients with BAO. We compared responses between physicians from HIC and MIC.


Among the 1245 respondents from 73 countries, 799 (64.2%) were from HIC, with the remaining 393 (31.6%) from MIC. Most respondents perceived that EVT was superior to medical management for acute BAO, but more so in respondents from HIC (98.0% vs. 94.2%, p < 0.01). MIC respondents were more likely to believe further RCTs were warranted (91.6% vs. 74.0%, p < 0.01) and were more likely to find it acceptable to enroll any patient who met a trial's criteria in the standard medical treatment arm (58.8% vs. 38.5%, p < 0.01).


In an area where clinical equipoise was called into question despite the lack of RCT evidence, we found that respondents from MIC were more likely to express willingness to enroll patients with BAO in an RCT than their HIC counterparts.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Fischer, Urs Martin, Kaesmacher, Johannes


600 Technology > 610 Medicine & health




Sage Publications




Pubmed Import

Date Deposited:

19 Dec 2022 14:27

Last Modified:

10 Jan 2023 00:16

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Uncontrolled Keywords:

Basilar artery occlusion high-income country intravenous thrombolysis mechanical thrombectomy middle-income country




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