Basilar Artery Occlusion Thrombectomy Technique: An International Survey of Practice Patterns
Authors: Klein Piers , Herning Ana , Drumm Brian , Raymond Jean , Abdalkader Mohamad , Siegler James E. , Chen Yimin , Huo Xiaochuan , Schonewille Wouter J. , Liu Xinfeng , Hu Wei , Ji Xunming , Lapergue Bertrand , Li Chuanhui , Alemseged Fana , Strbian Daniel , Fischer Urs , Kaesmacher Johannes , Yamagami Hiroshi , Puetz Volker , Sacco Simona , Kristoffersen Espen Saxhaug , Demeestere Jelle , Lobotesis Kyriakos , Roi Dylan , Aydin Kubilay , Diana Francesco , Masoud Hesham E. , Ma Alice , Novakovic‐White Roberta , Al‐Mufti Fawaz , Zhu Yuyou , Sang Hongfei , Sun Dapeng , Nguyen Thang Huy , Ton Mai Duy , Gentric Jean‐Christophe , Caroff Jildaz , Psychogios Marios‐Nikos , Consoli Arturo , Meyer Lukas , Fiehler Jens , English Joey , Gupta Rishi , Yan Bernard , Campbell Bruce , Jadhav Ashutosh P. , Lee Jin Soo , Thomalla Götz , Nagel Simon , Yang Qingwu , Zaidat Osama O. , Qiu Zhongming , Miao Zhongrong , Banerjee Soma , Nguyen Thanh N. 
Published: November 2022

Background
Two recent trials demonstrated a benefit for endovascular therapy (EVT) in the treatment of basilar artery occlusion (BAO). In light of the expected increase in the use of EVT for BAO, we sought to understand the technique preferences of neurointerventionalists performing EVT for BAO.

Methods
We conducted an international online survey of physician opinions on the use of EVT in BAO between January and 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. Responses from neurointerventionalists were analyzed.

Results
More than 3000 participants were invited yielding 1245 respondents, of whom 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 posterior cerebral artery, without regard for prior intravenous thrombolysis. For BAO of embolic etiology, aspiration only thrombectomy was the preferred method of 50.3% of neurointerventionalists. For BAO of intracranial atherosclerotic disease etiology, combined stent retriever and aspiration thrombectomy was the preferred method of 40.5% of neurointerventionalists. The majority of neurointerventionalists (88.0%) would proceed to stenting after 3 or fewer failed passes for patients with BAO of intracranial atherosclerotic disease etiology. In patients undergoing stenting, aspirin and clopidogrel was the most common antiplatelet regime (52.4%).

Conclusions
Among 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 intracranial atherosclerotic disease, the majority of neurointerventionalists were willing to stent and do so most often after 3 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 intracranial atherosclerotic disease.

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