What is a Challenging Clot? : A DELPHI Consensus Statement from the CLOTS 7.0 Summit.

Autor: Ospel JM; Departments of Diagnostic Imaging and Clinical Neurosciences, Foothills Medical Centre, University of Calgary, 1403 29th St. NW, T2N2T9, Calgary, AB, Canada. johannaospel@gmail.com., Mirza M; Cerenovus, Galway, Ireland., Clarençon F; Department of Neuroradiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France., Siddiqui A; Department of Neurosurgery, University of New York at Buffalo, Buffalo, NY, USA., Doyle K; Department of Physiology and CURAM-SFI Research Centre for Medical Devices, University of Galway, Galway, Ireland., Consoli A; Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Foch, Suresnes, France., Mokin M; Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA., Ullberg T; Departments of Neurology and Diagnostic Imaging, Skåne University Hospital, and Department of clinical sciences, Neurology, Lund University, Lund, Sweden., Zaidat O; Neuroscience and Stroke Center, Mercy Health Bon Secours St Vincent Hospital, Toledo, OH, USA., Bourcier R; Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, L'institut du thorax, Nantes, Pays de la Loire, France., Kulcsar Z; Department of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland., Gounis MJ; New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, USA., Liebeskind DS; UCLA Stroke Center and Department of Neurology, University of California, Los Angeles, USA., Fiehler J; Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Narata AP; Department of Interventional Neuroradiology, University Hospital of Southampton, Southampton, UK., Ribo M; Unitat d'Ictus, Hospital Universitari Vall d'Hebron, Barcelona, Spain., Jovin T; Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA., Sakai N; Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan., Rai A; Neuroradiology Department, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, USA., McCarthy R; Research and Development, Cerenovus, Galway, Ireland., Dorn F; Department of Neuroradiology, University Hospital of Bonn, Bonn, Germany., Andersson T; Department of Neuroradiology, Karolinska University Hospital and Clinical Neuroscience, Karolinska Intitutet, Stockholm, Sweden., Majoie CBLM; Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands., Hanel R; Baptist neurological institute, Baptist Health, Jacksonville, FL, USA., Jadhav A; Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA., Riedel C; Department of Neuroradiology, University Hospital Göttingen, Georg-August-University, Göttingen, Germany., Chamorro A; Hospital Clinic of Barcelona and Institut d'Investigaçions Biomèdicas August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain., Brinjikji W; Department of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, MN, USA., Costalat V; Neuroradiology department, University Hospital Güi-de-Chauliac, CHU de Montpellier, Montpellier, France., DeMeyer SF; Laboratory For Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium., Nogueira RG; Department of Neurology, University of Pittsburgh Medical Centre, Pittsburgh, USA., Cognard C; Department of diagnostic and therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France., Montaner J; Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR) Barcelona, Barcelona, Spain., Leung TW; Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China., Molina C; Stroke Center Vall d'Hebron Hospital, Barcelona, Spain., van Beusekom H; Department of Cardiology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands., Davalos A; Department of Neuroscience, University Autònoma de Barcelona, Barcelona, Spain., Weisel J; Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA., Chapot R; Department of Neuroradiology, Alfried Krupp Krankenhaus Ruttenscheid, Essen, Germany., Möhlenbruch M; Department of Interventional Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany., Brouwer P; Head World Wide Medical Affairs, Cerenovus, Galway, Ireland.
Jazyk: angličtina
Zdroj: Clinical neuroradiology [Clin Neuroradiol] 2023 Dec; Vol. 33 (4), pp. 1007-1016. Date of Electronic Publication: 2023 Jun 07.
DOI: 10.1007/s00062-023-01301-2
Abstrakt: Background: Predicting a challenging clot when performing mechanical thrombectomy in acute stroke can be difficult. One reason for this difficulty is a lack of agreement on how to precisely define these clots. We explored the opinions of stroke thrombectomy and clot research experts regarding challenging clots, defined as difficult to recanalize clots by endovascular approaches, and clot/patient features that may be indicative of such clots.
Methods: A modified DELPHI technique was used before and during the CLOTS 7.0 Summit, which included experts in thrombectomy and clot research from different specialties. The first round included open-ended questions and the second and final rounds each consisted of 30 closed-ended questions, 29 on various clinical and clot features, and 1 on number of passes before switching techniques. Consensus was defined as agreement ≥ 50%. Features with consensus and rated ≥ 3 out of 4 on the certainty scale were included in the definition of a challenging clot.
Results: Three DELPHI rounds were performed. Panelists achieved consensus on 16/30 questions, of which 8 were rated 3 or 4 on the certainty scale, namely white-colored clots (mean certainty score 3.1), calcified clots under histology (3.7) and imaging (3.7), stiff clots (3.0), sticky/adherent clots (3.1), hard clots (3.1), difficult to pass clots (3.1) and clots that are resistant to pulling (3.0). Most panelists considered switching endovascular treatment (EVT) techniques after 2-3 unsuccessful attempts.
Conclusion: This DELPHI consensus identified 8 distinct features of a challenging clot. The varying degree of certainty amongst the panelists emphasizes the need for more pragmatic studies to enable accurate a priori identification of such occlusions prior to EVT.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)
Databáze: MEDLINE
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