Experience-driven differences in acute ischemic stroke management: A nationwide study

Recent advancements in endovascular thrombectomy (EVT) devices and pivotal trial evidence have revolutionised acute ischemic stroke management. However, translational gaps persist between guideline recommendations and real-world practice, particularly regarding operator experience-dependent technical preferences in resource allocation.

A national survey with 53 questions was designed to extract information regarding strategy decisions and clinical scenarios, including technical variations of thrombectomy and thrombolysis, blood pressure preference. The survey link was sent individually via email with a website link.

1,289 responses from 883 hospitals were obtained and were included in the final analysis. Junior physicians exhibited reluctance to deviate from thrombolysis-centric paradigms, while senior physicians preferred thrombectomy. Conversely, junior physicians were more likely to use Balloon-guide catheters (BGC), thrombolysis after thrombectomy, local anesthesia, and radial access.

This nationwide study highlights significant heterogeneity in acute ischemic stroke management among Chinese physicians, driven by experience-based differences. Findings underscore the need for stratified training, standardized protocols, and collaborative platforms to harmonize practice and accelerate evidence translation.