TY - JOUR
T1 - What is a Challenging Clot?
T2 - A DELPHI Consensus Statement from the CLOTS 7.0 Summit
AU - Ospel, Johanna M.
AU - Mirza, Mahmood
AU - Clarençon, Frédéric
AU - Siddiqui, Adnan
AU - Doyle, Karen
AU - Consoli, Arturo
AU - Mokin, Maxim
AU - Ullberg, Teresa
AU - Zaidat, Osama
AU - Bourcier, Romain
AU - Kulcsar, Zsolt
AU - Gounis, Matthew J.
AU - Liebeskind, David S.
AU - Fiehler, Jens
AU - Narata, Ana Paula
AU - Ribo, Marc
AU - Jovin, Tudor
AU - Sakai, Nobuyuki
AU - Rai, Ansaar
AU - McCarthy, Ray
AU - Dorn, Franziska
AU - Andersson, Tommy
AU - Majoie, Charles B. L. M.
AU - Hanel, Ricardo
AU - Jadhav, Ashutosh
AU - Riedel, Christian
AU - Chamorro, Angel
AU - Brinjikji, Waleed
AU - Costalat, Vincent
AU - DeMeyer, Simon F.
AU - Nogueira, Raul G.
AU - Cognard, Christophe
AU - Montaner, Joan
AU - Leung, Thomas W.
AU - Molina, Carlos
AU - van Beusekom, Heleen
AU - Davalos, Antoni
AU - Weisel, John
AU - Chapot, Rene
AU - Möhlenbruch, Markus
AU - Brouwer, Patrick
N1 - Funding Information: J.M. Ospel: consultant (NICOLab). M. Mirza: employee, Cerenovus. F. Clarençon: Medtronic, Balt Extrusion, Stryker, Microvention (consultant), ClinSearch (core lab), Penumbra (payment for reading), Artedrone (Board), Collavidence and Intradys (stock options). M. Mokin: grants: NIH; consultant: Cerenovus, Medtronic, Microvention; stock options: Bendit Technologies, Borvo medical, BrainQ, Endostream, Serenity medical, Synchron, Sim&Cure, QAS.AI, Quantanosis.AI. J. Fiehler: research support: German Ministry of Science and Education (BMBF), German Ministry of Economy and Innovation (BMWi), German Research Foundation (DFG), European Union (EU), Hamburgische Investitions- und Förderbank (IFB), Medtronic, Microvention, Route92, Stryker, consultant for: Cerenovus, Medtronic, Microvention, Penumbra, Phenox, Roche. Stock holder: Tegus Medical, Vastrax, Eppdata. A. Rai: consulting agreement with Cerenovus/Stryker. R. McCarthy: employee, Cerenovus. F. Dorn: consulting and proctoring fees from Cerenovus, Balt Germany, Cerus Endovascular, speakers honoraria from Stryker, Cerenovus, Acandis, Asahi Inc. and research funding from Cerenovus. T. Andersson: consultant for Anaconda, Cerenovus, Optimize Neurovascular and Rapid Medical. Shares in Ceroflo. C. B.L.M. Majoie: grants from CVON/Dutch Heart Foundation, TWIN Foundation, European Commission, Healthcare Evaluation Netherlands, and Stryker outside the submitted work; (minority interest) shareholder of Nico.lab. R. Hanel: consultant for Medtronic, Stryker, Cerenovous, Microvention, Balt, Phenox, Rapid Medical, and Q’Apel, advisory board: MiVI, eLum, Three Rivers, Shape Medical and Corindus, unrestricted research grant from NIH, Interline Endowment, Microvention, Stryker, CNX, investor/stockholder: InNeuroCo, Cerebrotech, eLum, Endostream, Three Rivers Medical Inc, Scientia, RisT, BlinkTBI, and Corindus. C. Cognard: consultant for Medtronic, Microvention, MIVI, Stryker. H. van Beusekom: grants from CVON/Dutch Heart Foundation. M. Möhlenbruch: grants outside this work from Balt, Covidien/Medtronic, MicroVention and Stryker. P. Brouwer: Employee, Cerenovus. A. Siddiqui, K. Doyle, A. Consoli, T. Ullberg, O. Zaidat, R. Bourcier, Z. Kulcsar, M.J. Gounis, D.S. Liebeskind, A.P. Narata, M. Ribo, T. Jovin, N. Sakai, A. Jadhav, C. Riedel, A. Chamorro, W. Brinjikji, V. Costalat, S.F. DeMeyer, R.G. Nogueira, J. Montaner, T.W. Leung, C. Molina, A. Davalos, J. Weisel and R. Chapot declare that they have no competing interests. Publisher Copyright: © 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
PY - 2023/12
Y1 - 2023/12
N2 - 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.
AB - 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.
KW - Acute ischemic stroke
KW - Intracranial vessel occlusion
KW - Neurovascular disease
KW - Thrombectomy
KW - Thrombus
UR - http://www.scopus.com/inward/record.url?scp=85161309291&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00062-023-01301-2
DO - https://doi.org/10.1007/s00062-023-01301-2
M3 - Article
C2 - 37284876
SN - 1869-1439
VL - 33
SP - 1007
EP - 1016
JO - Clinical neuroradiology
JF - Clinical neuroradiology
IS - 4
ER -