Departments of Diagnostic Imaging and Clinical Neurosciences, Foothills Medical Centre, University of Calgary, 1403 29th St. NW, T2N2T9, Calgary, AB, Canada.
Cerenovus, Galway, Ireland.
Clin Neuroradiol. 2023 Dec;33(4):1007-1016. doi: 10.1007/s00062-023-01301-2. Epub 2023 Jun 7.
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.
在急性脑卒中进行机械取栓时，预测血栓取出困难较为困难。造成这种困难的原因之一是缺乏精确定义这些血栓的共识。我们探讨了急性脑卒中取栓和血栓研究专家对于取栓困难的意见，这些血栓定义为通过血管内途径难以再通的血栓，以及可能提示此类血栓的血栓/患者特征。
采用改良的德尔菲（DELPHI）技术，在 CLOTS 7.0 峰会之前和期间，邀请了来自不同专业的取栓和血栓研究专家参与。第一轮包括开放性问题，第二轮和第三轮各包含 30 个封闭式问题，其中 29 个涉及各种临床和血栓特征，1 个涉及更换技术前的通过次数。共识定义为≥50%的专家意见一致。在置信度评分上≥3 分且达到共识的特征被纳入取栓困难的定义中。
进行了三轮 DELPHI。在 30 个问题中有 16 个问题达成共识，其中 8 个问题在置信度评分上达到 3 分或 4 分，即白色血栓（平均确定性评分 3.1）、组织学（3.7）和影像学（3.7）下的钙化血栓、硬血栓（3.0）、粘性/黏附性血栓（3.1）、坚硬血栓（3.1）、难以通过的血栓（3.1）和难以牵拉的血栓（3.0）。大多数专家认为，在 2-3 次尝试不成功后，应更换血管内治疗（EVT）技术。
这项 DELPHI 共识确定了 8 种有区别的取栓困难血栓特征。专家之间的置信度存在差异，这强调需要更多的实际研究，以便在 EVT 之前准确地预先识别出这些闭塞。
