Basilar artery occlusion management: An international survey of gender influence on management

Meabh Peacock¹, Brian Drumm^{1

2}, Piers Klein³, Jean Raymond⁴, Xiaochuan Huo⁵, Yimin Chen⁶, Mohamad Abdalkader³, Wouter J Schonewille⁷, Xinfeng Liu⁸, Wei Hu⁸, Chuanhui Li⁹, Xunming Ji¹⁰, Fana Alemseged¹¹, Liping Liu¹², James E Siegler^{13

14}, Simon Nagel^{15

16}, Daniel Strbian¹⁷, Simona Sacco¹⁸, Shadi Yaghi¹⁹, Muhammad M Qureshi³, Urs Fischer^{20

21}, Diana Aguiar de Sousa²², Hiroshi Yamagami²³, Patrik Michel²⁴, Volker Puetz^{25

26}, Adnan Mujanovic²⁷, João Pedro Marto²⁸, Espen Saxhaug Kristoffersen²⁹, Else C Sandset^{30

31}, Jelle Demeestere³², Uta Hanning³³, Robin Novakovic³⁴, Cynthia Kenmuir³⁵, Ronit Agid³⁶, Michele Romoli³⁷, Francesco Diana³⁸, Kyriakos Lobotesis³⁹, Dylan Roi³⁹, Hesham E Masoud⁴⁰, Alice Ma⁴¹, Yuyou Zhu⁸, Hongfei Sang⁴², Dapeng Sun⁵, Mai Duy Ton^{43

44}, Raynald⁵, Fengli Li⁴⁵, Ahmed Nasreldein⁴⁶, Jessica Jesser⁴⁷, Johannes Kaesmacher²⁷, Charlotte S Weyland⁴⁸, Lukas Meyer³³, Leonard L L Yeo⁴⁹, Qingwu Yang⁴⁵, Götz Thomalla⁵⁰, Pengfei Yang⁵¹, Sven Poli⁵², Bruce C V Campbell¹¹, Adnan I Qureshi⁵³, Hui-Sheng Chen⁵⁴, Osama O Zaidat⁵⁵, Zhongming Qiu⁵⁶, Raul G Nogueira⁵⁷, Tudor G Jovin^{13

14}, Zhongrong Miao⁵, Thanh N Nguyen^{3

58}, Soma Banerjee¹

Affiliations

¹ Department of Stroke Medicine, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.
² Department of Stroke Medicine, Chelsea and Westminster NHS Trust, London, UK.
³ Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
⁴ Department of Radiology, Interventional Neuroradiology Division, Centre Hospitalier de l'Universite de Montreal, Montreal, Canada.
⁵ Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China.
⁶ Department of Neurology, Foshan Sanshui District People's Hospital, Foshan, China.
⁷ Department of Neurology, St Antonius Hospital, Nieuwegein, the Netherlands.
⁸ 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.
⁹ Neurology, Xuanwu Hospital, Beijing, China.
¹⁰ Department of Neurosurgery, Xuanwu Hospital, Beijing, China.
¹¹ Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.
¹² Neurology, Beijing Tiantan Hospital, Beijing, China.
¹³ Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA.
¹⁴ Cooper Medical School of Rowan University, Camden, NJ, USA.
¹⁵ Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
¹⁶ Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany.
¹⁷ Department of Neurology, Helsinki University Hospital, Helsinki, Finland.
¹⁸ Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
¹⁹ Department of Neurology, Rhode Island Hospital, Brown University, Providence, RI, USA.
²⁰ Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland.
²¹ Department of Neurology, Basel University Hospital, University of Basel, Basel, Switzerland.
²² Stroke Center, Lisbon Central University Hospital and Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
²³ Department of Stroke Neurology, National Hospital Organization, Osaka National Hospital, Japan.
²⁴ Stroke Center, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland.
²⁵ Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
²⁶ Dresden Neurovascular Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
²⁷ Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland.
²⁸ Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
²⁹ Department of Neurology, Akershus University Hospital, Lørenskog, Norway and Department of General Practice, University of Oslo, Oslo, Norway.
³⁰ Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, Norway.
³¹ The Norwegian Air Ambulance, Oslo, Norway.
³² Neurology Department, Leuven University Hospital, Leuven, Belgium.
³³ Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
³⁴ Department of Neurology and Radiology, UT Southwestern, Dallas, TX, USA.
³⁵ Department of Neurology, UPMC, Pittsburgh, PA, USA.
³⁶ Division of Interventional Neuroradiology, Toronto Western Hospital, JDMI, UHN, University of Toronto, Toronto, Canada.
³⁷ Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy.
³⁸ Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain.
³⁹ Interventional Neuroradiology Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.
⁴⁰ Department of Neurology, SUNY Upstate Medical University, Syracuse, NY, USA.
⁴¹ Department of Neurosurgery, Royal North Shore Hospital, Sydney, Australia.
⁴² Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
⁴³ Stroke Center, Bach Mai Hospital, Hanoi Medical University, Hanoi, Vietnam.
⁴⁴ Faculty of Stroke and Cerebrovascular Disease, VNU-University of Medicine and Pharmacy, Hanoi, Vietnam.
⁴⁵ Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, China.
⁴⁶ Neurology, Assiut University Hospitals, Assiut University, Assiut, Egypt.
⁴⁷ Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.
⁴⁸ Interventional Neuroradiology, Aachen University, Aachen, Germany.
⁴⁹ Division of Neurology, Department of Medicine, National University Hospital, Singapore and Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
⁵⁰ Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁵¹ Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China.
⁵² Department of Neurology, University of Tuebingen, Tübingen, Germany.
⁵³ Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA.
⁵⁴ Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, China.
⁵⁵ Neuroscience and Stroke Program, Bon Secours Mercy Health St Vincent Hospital, Toledo, USA.
⁵⁶ Department of Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China.
⁵⁷ Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
⁵⁸ Neurology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.

PMID: 39140366
DOI: 10.1177/15910199241265590

Basilar artery occlusion management: An international survey of gender influence on management

Meabh Peacock et al. Interv Neuroradiol. 2024.

. 2024 Aug 14:15910199241265590.

doi: 10.1177/15910199241265590. Online ahead of print.

Authors

Affiliations

¹ Department of Stroke Medicine, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.
² Department of Stroke Medicine, Chelsea and Westminster NHS Trust, London, UK.
³ Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
⁴ Department of Radiology, Interventional Neuroradiology Division, Centre Hospitalier de l'Universite de Montreal, Montreal, Canada.
⁵ Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China.
⁶ Department of Neurology, Foshan Sanshui District People's Hospital, Foshan, China.
⁷ Department of Neurology, St Antonius Hospital, Nieuwegein, the Netherlands.
⁸ 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.
⁹ Neurology, Xuanwu Hospital, Beijing, China.
¹⁰ Department of Neurosurgery, Xuanwu Hospital, Beijing, China.
¹¹ Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.
¹² Neurology, Beijing Tiantan Hospital, Beijing, China.
¹³ Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA.
¹⁴ Cooper Medical School of Rowan University, Camden, NJ, USA.
¹⁵ Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
¹⁶ Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany.
¹⁷ Department of Neurology, Helsinki University Hospital, Helsinki, Finland.
¹⁸ Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
¹⁹ Department of Neurology, Rhode Island Hospital, Brown University, Providence, RI, USA.
²⁰ Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland.
²¹ Department of Neurology, Basel University Hospital, University of Basel, Basel, Switzerland.
²² Stroke Center, Lisbon Central University Hospital and Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
²³ Department of Stroke Neurology, National Hospital Organization, Osaka National Hospital, Japan.
²⁴ Stroke Center, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland.
²⁵ Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
²⁶ Dresden Neurovascular Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
²⁷ Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland.
²⁸ Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
²⁹ Department of Neurology, Akershus University Hospital, Lørenskog, Norway and Department of General Practice, University of Oslo, Oslo, Norway.
³⁰ Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, Norway.
³¹ The Norwegian Air Ambulance, Oslo, Norway.
³² Neurology Department, Leuven University Hospital, Leuven, Belgium.
³³ Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
³⁴ Department of Neurology and Radiology, UT Southwestern, Dallas, TX, USA.
³⁵ Department of Neurology, UPMC, Pittsburgh, PA, USA.
³⁶ Division of Interventional Neuroradiology, Toronto Western Hospital, JDMI, UHN, University of Toronto, Toronto, Canada.
³⁷ Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy.
³⁸ Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain.
³⁹ Interventional Neuroradiology Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.
⁴⁰ Department of Neurology, SUNY Upstate Medical University, Syracuse, NY, USA.
⁴¹ Department of Neurosurgery, Royal North Shore Hospital, Sydney, Australia.
⁴² Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
⁴³ Stroke Center, Bach Mai Hospital, Hanoi Medical University, Hanoi, Vietnam.
⁴⁴ Faculty of Stroke and Cerebrovascular Disease, VNU-University of Medicine and Pharmacy, Hanoi, Vietnam.
⁴⁵ Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, China.
⁴⁶ Neurology, Assiut University Hospitals, Assiut University, Assiut, Egypt.
⁴⁷ Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.
⁴⁸ Interventional Neuroradiology, Aachen University, Aachen, Germany.
⁴⁹ Division of Neurology, Department of Medicine, National University Hospital, Singapore and Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
⁵⁰ Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁵¹ Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China.
⁵² Department of Neurology, University of Tuebingen, Tübingen, Germany.
⁵³ Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA.
⁵⁴ Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, China.
⁵⁵ Neuroscience and Stroke Program, Bon Secours Mercy Health St Vincent Hospital, Toledo, USA.
⁵⁶ Department of Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China.
⁵⁷ Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
⁵⁸ Neurology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.

PMID: 39140366
DOI: 10.1177/15910199241265590

Abstract

Background: The superiority of endovascular thrombectomy (EVT) over medical management was not established in two early basilar artery occlusion (BAO) randomized controlled trials. Despite this, many clinicians recommended EVT for acute BAO under certain circumstances. This paper aims to compare physicians' diagnostic and management strategies of BAO according to gender.

Methods: From January to March 2022 an international survey was conducted regarding management strategies in acute BAO. We compared responses between clinicians by identifying gender. Questions were designed to examine clinical and imaging parameters influencing management of patients with BAO.

Results: Among the 1245 respondents from 73 countries, 311 (25.0%) identified as female. This figure was 13.6% amongst interventionists. Geographically, female respondents were lowest in Asia (14.5%) and North America (23.9%). The proportion of respondents identifying as female was consistent regardless of their years of experience. Female respondents were more likely to choose time of onset as time of first estimated stroke like symptom (48.0% vs. 38.5%, p < .01), were less likely to favor thrombectomy in the V4 segment of vertebrobasilar artery occlusions (31.5% vs. 43.3%, p < .01), and were less likely to find it acceptable to enroll all patients who met trial criteria in the standard medical treatment arm of a clinical trial (41.2% vs. 47.0%, p = .01). Male respondents were more likely to agree that thrombolysis would not alter their decision on proceeding with EVT (93.7% vs. 88.3%, p < .01).

Conclusions: Female clinicians appear to be significantly underrepresented in stroke medicine. This is most pronounced amongst interventionists and in Asia. Although male and female opinions were closely aligned on many aspects of BAO management, differences in opinion were observed in a number of significant areas which influence decision making.

Keywords: Stroke; basilar artery occlusion; mechanical thrombectomy.

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Basilar artery occlusion management: An international survey of gender influence on management

Affiliations

Basilar artery occlusion management: An international survey of gender influence on management

Authors

Affiliations

Abstract

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