What is a Challenging Clot? : A DELPHI Consensus Statement from the CLOTS 7.0 Summit
(2023) In Clinical Neuroradiology 33(4). p.1007-1016- Abstract
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... (More)
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.
(Less)
- author
- organization
- publishing date
- 2023
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Acute ischemic stroke, Intracranial vessel occlusion, Neurovascular disease, Thrombectomy, Thrombus
- in
- Clinical Neuroradiology
- volume
- 33
- issue
- 4
- pages
- 1007 - 1016
- publisher
- Springer
- external identifiers
-
- pmid:37284876
- scopus:85161309291
- ISSN
- 1869-1439
- DOI
- 10.1007/s00062-023-01301-2
- language
- English
- LU publication?
- yes
- id
- 55aa3e9f-73f3-43d7-95b3-449d1e049242
- date added to LUP
- 2023-08-31 15:30:27
- date last changed
- 2024-04-20 02:19:32
@article{55aa3e9f-73f3-43d7-95b3-449d1e049242,
abstract = {{<p>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.</p>}},
author = {{Ospel, Johanna M. and Mirza, Mahmood and Clarençon, Frédéric and Siddiqui, Adnan and Doyle, Karen and Consoli, Arturo and Mokin, Maxim and Ullberg, Teresa and Zaidat, Osama and Bourcier, Romain and Kulcsar, Zsolt and Gounis, Matthew J. and Liebeskind, David S. and Fiehler, Jens and Narata, Ana Paula and Ribo, Marc and Jovin, Tudor and Sakai, Nobuyuki and Rai, Ansaar and McCarthy, Ray and Dorn, Franziska and Andersson, Tommy and Majoie, Charles B.L.M. and Hanel, Ricardo and Jadhav, Ashutosh and Riedel, Christian and Chamorro, Angel and Brinjikji, Waleed and Costalat, Vincent and DeMeyer, Simon F. and Nogueira, Raul G. and Cognard, Christophe and Montaner, Joan and Leung, Thomas W. and Molina, Carlos and van Beusekom, Heleen and Davalos, Antoni and Weisel, John and Chapot, Rene and Möhlenbruch, Markus and Brouwer, Patrick}},
issn = {{1869-1439}},
keywords = {{Acute ischemic stroke; Intracranial vessel occlusion; Neurovascular disease; Thrombectomy; Thrombus}},
language = {{eng}},
number = {{4}},
pages = {{1007--1016}},
publisher = {{Springer}},
series = {{Clinical Neuroradiology}},
title = {{What is a Challenging Clot? : A DELPHI Consensus Statement from the CLOTS 7.0 Summit}},
url = {{http://dx.doi.org/10.1007/s00062-023-01301-2}},
doi = {{10.1007/s00062-023-01301-2}},
volume = {{33}},
year = {{2023}},
}