What is a Challenging Clot?
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What is a Challenging Clot? A DELPHI Consensus Statement from the CLOTS 7.0 Summit. / Ospel, Johanna M; Mirza, Mahmood; Clarençon, Frédéric; Siddiqui, Adnan; Doyle, Karen; Consoli, Arturo; Mokin, Maxim; Ullberg, Teresa; Zaidat, Osama; Bourcier, Romain; Kulcsar, Zsolt; Gounis, Matthew J; Liebeskind, David S; Fiehler, Jens; Narata, Ana Paula; Ribo, Marc; Jovin, Tudor; Sakai, Nobuyuki; Rai, Ansaar; McCarthy, Ray; Dorn, Franziska; Andersson, Tommy; Majoie, Charles B L M; Hanel, Ricardo; Jadhav, Ashutosh; Riedel, Christian; Chamorro, Angel; Brinjikji, Waleed; Costalat, Vincent; DeMeyer, Simon F; Nogueira, Raul G; Cognard, Christophe; Montaner, Joan; Leung, Thomas W; Molina, Carlos; van Beusekom, Heleen; Davalos, Antoni; Weisel, John; Chapot, Rene; Möhlenbruch, Markus; Brouwer, Patrick.
In: CLIN NEURORADIOL, Vol. 33, No. 4, 12.2023, p. 1007-1016.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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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 - © 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 - Humans
KW - Delphi Technique
KW - Thrombosis/diagnostic imaging
KW - Stroke/diagnostic imaging
KW - Thrombectomy/methods
KW - Endovascular Procedures/methods
KW - Brain Ischemia/pathology
KW - Treatment Outcome
U2 - 10.1007/s00062-023-01301-2
DO - 10.1007/s00062-023-01301-2
M3 - SCORING: Journal article
C2 - 37284876
VL - 33
SP - 1007
EP - 1016
JO - CLIN NEURORADIOL
JF - CLIN NEURORADIOL
SN - 1869-1439
IS - 4
ER -
