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

Johanna M Ospel; Mahmood Mirza; Frédéric Clarençon; Adnan Siddiqui; Karen Doyle; Arturo Consoli; Maxim Mokin; Teresa Ullberg; Osama Zaidat; Romain Bourcier; Zsolt Kulcsar; Matthew J Gounis; David S Liebeskind; Jens Fiehler; Ana Paula Narata; Marc Ribo; Tudor Jovin; Nobuyuki Sakai; Ansaar Rai; Ray McCarthy; Franziska Dorn; Tommy Andersson; Charles B L M Majoie; Ricardo Hanel; Ashutosh Jadhav; Christian Riedel; Angel Chamorro; Waleed Brinjikji; Vincent Costalat; Simon F DeMeyer; Raul G Nogueira; Christophe Cognard; Joan Montaner; Thomas W Leung; Carlos Molina; Heleen van Beusekom; Antoni Davalos; John Weisel; Rene Chapot; Markus Möhlenbruch; Patrick Brouwer; Faculty of Medicine

doi:10.1007/s00062-023-01301-2

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

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

Johanna M Ospel, Mahmood Mirza, Frédéric Clarençon, Adnan Siddiqui, Karen Doyle, Arturo Consoli, Maxim Mokin, Teresa Ullberg, Osama Zaidat, Romain Bourcier, …

Clinical neuroradiology (Munich), Vol.33(4), pp.1007-1016

01/12/2023

DOI: https://doi.org/10.1007/s00062-023-01301-2

PMID: 37284876

Résumé

Brain Ischemia - pathology

Consensus Development Conferences as Topic

Delphi Technique

Endovascular Procedures - methods

Humans

Stroke - diagnostic imaging

Stroke - surgery

Thrombectomy - methods

Thrombosis - diagnostic imaging

Thrombosis - pathology

Thrombosis - therapy

Treatment Outcome

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. 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. 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. 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.

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Titre: What is a Challenging Clot? : A DELPHI Consensus Statement from the CLOTS 7.0 Summit
Créateurs - sans rôle: Johanna M Ospel - University of Calgary
Mahmood Mirza - Cerenovus, Galway, Ireland
Frédéric Clarençon - Department of Neuroradiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
Adnan Siddiqui - Department of Neurosurgery, University of New York at Buffalo, Buffalo, NY, USA
Karen Doyle - Department of Physiology and CURAM-SFI Research Centre for Medical Devices, University of Galway, Galway, Ireland
Arturo Consoli - Hôpital Foch
Maxim Mokin - University of South Florida
Teresa Ullberg - Departments of Neurology and Diagnostic Imaging, Skåne University Hospital, and Department of clinical sciences, Neurology, Lund University, Lund, Sweden
Osama Zaidat - St. Vincent Hospital
Romain Bourcier - Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, L'institut du thorax, Nantes, Pays de la Loire, France
Zsolt Kulcsar - Department of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland
Matthew J Gounis - New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, USA
David S Liebeskind - UCLA Stroke Center and Department of Neurology, University of California, Los Angeles, USA
Jens Fiehler - Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
Ana Paula Narata - Department of Interventional Neuroradiology, University Hospital of Southampton, Southampton, UK
Marc Ribo - Unitat d'Ictus, Hospital Universitari Vall d'Hebron, Barcelona, Spain
Tudor Jovin - Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA
Nobuyuki Sakai - Kobe City Medical Center General Hospital
Ansaar Rai - Neuroradiology Department, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, USA
Ray McCarthy - Research and Development, Cerenovus, Galway, Ireland
Franziska Dorn - Department of Neuroradiology, University Hospital of Bonn, Bonn, Germany
Tommy Andersson - Department of Neuroradiology, Karolinska University Hospital and Clinical Neuroscience, Karolinska Intitutet, Stockholm, Sweden
Charles B L M Majoie - Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
Ricardo Hanel - The Neurological Institute
Ashutosh Jadhav - Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
Christian Riedel - Department of Neuroradiology, University Hospital Göttingen, Georg-August-University, Göttingen, Germany
Angel Chamorro - Hospital Clinic of Barcelona and Institut d'Investigaçions Biomèdicas August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
Waleed Brinjikji - Department of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, MN, USA
Vincent Costalat - Neuroradiology department, University Hospital Güi-de-Chauliac, CHU de Montpellier, Montpellier, France
Simon F DeMeyer - Laboratory For Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
Raul G Nogueira - University of Pittsburgh
Christophe Cognard - Department of diagnostic and therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France
Joan Montaner - Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR) Barcelona, Barcelona, Spain
Thomas W Leung - Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
Carlos Molina - Stroke Center Vall d'Hebron Hospital, Barcelona, Spain
Heleen van Beusekom - Department of Cardiology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
Antoni Davalos - Department of Neuroscience, University Autònoma de Barcelona, Barcelona, Spain
John Weisel - Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
Rene Chapot - Department of Neuroradiology, Alfried Krupp Krankenhaus Ruttenscheid, Essen, Germany
Markus Möhlenbruch - University Hospital Heidelberg
Patrick Brouwer - Head World Wide Medical Affairs, Cerenovus, Galway, Ireland
Faculty of Medicine
Détails de publication: Clinical neuroradiology (Munich), Vol.33(4), pp.1007-1016
Note de subvention: not applicable (Cerenovus funded the transportation and accomodation for the CLOTS 7.0 panelists) / Cerenovus
Identifiants: 99163089109311
Unité académique: Institut de Génomique Fonctionnelle - IGF
Langue: English
Type de ressource: Journal article