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.
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.
摘要：
背景：在两项早期基底动脉闭塞（BAO）随机对照试验中，尚未确定血管内血栓切除术（EVT）优于医学治疗。尽管如此,在某些情况下，许多临床医生建议EVT治疗急性BAO。本文旨在根据性别比较医生对BAO的诊断和管理策略。
方法：2022年1月至3月，对急性BAO的管理策略进行了国际调查。我们通过识别性别比较了临床医生之间的反应。设计问题以检查影响BAO患者管理的临床和影像学参数。
结果：在来自73个国家的1245名受访者中，311（25.0％）被确定为女性。在干预主义者中，这一数字为13.6％。地理上,女性受访者最低的是亚洲(14.5%)和北美(23.9%).无论他们多年的经验如何，被认定为女性的受访者比例都是一致的。女性受访者更有可能选择发病时间作为首次估计中风样症状的时间(48.0%vs.38.5%,p<.01),不太可能倾向于椎基底动脉闭塞V4段的血栓切除术(31.5%vs.43.3%,p<.01),并且不太可能发现将所有符合试验标准的患者纳入临床试验的标准药物治疗组(41.2%vs.47.0%,p=.01）。男性受访者更有可能同意溶栓不会改变他们进行EVT的决定(93.7%vs.88.3%,p<.01)。
结论：女性临床医生在中风医学中的代表性明显不足。这在干预主义者和亚洲最为明显。尽管在BAO管理的许多方面，男性和女性的意见是一致的，在影响决策的许多重要领域观察到意见分歧。
方法：2022年1月至3月，对急性BAO的管理策略进行了国际调查。我们通过识别性别比较了临床医生之间的反应。设计问题以检查影响BAO患者管理的临床和影像学参数。
结果：在来自73个国家的1245名受访者中，311（25.0％）被确定为女性。在干预主义者中，这一数字为13.6％。地理上,女性受访者最低的是亚洲(14.5%)和北美(23.9%).无论他们多年的经验如何，被认定为女性的受访者比例都是一致的。女性受访者更有可能选择发病时间作为首次估计中风样症状的时间(48.0%vs.38.5%,p<.01),不太可能倾向于椎基底动脉闭塞V4段的血栓切除术(31.5%vs.43.3%,p<.01),并且不太可能发现将所有符合试验标准的患者纳入临床试验的标准药物治疗组(41.2%vs.47.0%,p=.01）。男性受访者更有可能同意溶栓不会改变他们进行EVT的决定(93.7%vs.88.3%,p<.01)。
结论：女性临床医生在中风医学中的代表性明显不足。这在干预主义者和亚洲最为明显。尽管在BAO管理的许多方面，男性和女性的意见是一致的，在影响决策的许多重要领域观察到意见分歧。
