Current Opinions on Optimal Management of Basilar Artery Occlusion: After the BEST of BASICS Survey

Authors	DRUMM Brian BANERJEE Soma Banerjee M QURESHI Muhammad SCHONEWILLE Wouter J KLEIN Piers HUO Xiaochuan Huo CHEN Yimin STRBIAN Daniel FISCHE Urs PUETZ Volker HU Wei JI Xunming LI Chuanhui ALEMSEGED Fana YAMAGAMI Hiroshi SACCO Simona SAPOSNIK Gustavo MICHEL Patrik SAXHAUG KRISTOFFERSEN Espen ŠEDOVÁ Petra MIKULÍK Robert SIEGLER James E MEINEL Thomas R DE SOUSA Diana Aguiar LOBOTESIS Kyriakos ROI Dylan DEMEESTERE Jelle ASIF Kaiz S PHD Sheila O Martins MD ABDALKADER Mohamad GOYAL Mayank NGUYEN Thang Huy TON Mai Duy ZHU Yuyou LIU Xinfeng QIU Zhongming MIAO Zhongrong CAROFF Jildaz ROMOLI Michele DIANA Francesco THOMALLA Götz NAGEL Simon SANDSET Else C CAMPBELL CV Bruce JOVIN Tudor G Jovin NOGUEIRA Raul G RAYMOND Jean NGUYEN Thanh N
Year of publication	2022
Type	Article in Periodical
Magazine / Source	Stroke: Vascular and Interventional Neurology
MU Faculty or unit	Faculty of Medicine
Citation
Web	https://www.ahajournals.org/doi/10.1161/SVIN.122.000538
Doi	http://dx.doi.org/10.1161/SVIN.122.000538
Keywords	Basilar Artery Occlusion
Description	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.