The Management of Persistent Distal Occlusions after Mechanical Thrombectomy and Thrombolysis: An Inter- and Intrarater Agreement Study.

Journal

AJNR. American journal of neuroradiology
ISSN: 1936-959X
Titre abrégé: AJNR Am J Neuroradiol
Pays: United States
ID NLM: 8003708

Informations de publication

Date de publication:
22 Feb 2024
Historique:
received: 22 08 2023
accepted: 24 10 2023
medline: 23 2 2024
pubmed: 23 2 2024
entrez: 22 2 2024
Statut: aheadofprint

Résumé

The best management of patients with persistent distal occlusion after mechanical thrombectomy with or without IV thrombolysis remains unknown. We sought to evaluate the variability and agreement in decision-making for persistent distal occlusions. A portfolio of 60 cases was sent to clinicians with varying backgrounds and experience. Responders were asked whether they considered conservative management or rescue therapy (stent retriever, aspiration, or intra-arterial thrombolytics) a treatment option as well as their willingness to enroll patients in a randomized trial. Agreement was assessed using κ statistics. The electronic survey was answered by 31 physicians (8 vascular neurologists and 23 interventional neuroradiologists). Decisions for rescue therapies were more frequent ( Individuals did not agree regarding the best management of patients with persistent distal occlusion after mechanical thrombectomy and IV thrombolysis. There is sufficient uncertainty to justify a dedicated randomized trial.

Sections du résumé

BACKGROUND AND PURPOSE OBJECTIVE
The best management of patients with persistent distal occlusion after mechanical thrombectomy with or without IV thrombolysis remains unknown. We sought to evaluate the variability and agreement in decision-making for persistent distal occlusions.
MATERIALS AND METHODS METHODS
A portfolio of 60 cases was sent to clinicians with varying backgrounds and experience. Responders were asked whether they considered conservative management or rescue therapy (stent retriever, aspiration, or intra-arterial thrombolytics) a treatment option as well as their willingness to enroll patients in a randomized trial. Agreement was assessed using κ statistics.
RESULTS RESULTS
The electronic survey was answered by 31 physicians (8 vascular neurologists and 23 interventional neuroradiologists). Decisions for rescue therapies were more frequent (
CONCLUSIONS CONCLUSIONS
Individuals did not agree regarding the best management of patients with persistent distal occlusion after mechanical thrombectomy and IV thrombolysis. There is sufficient uncertainty to justify a dedicated randomized trial.

Identifiants

DOI: 10.3174/ajnr.A8149 PMID: 38388684
pubmed: 38388684
pii: ajnr.A8149
doi: 10.3174/ajnr.A8149
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024 by American Journal of Neuroradiology.

Auteurs

W Boisseau (W)

From the Department of Interventional Neuroradiology (W.B., S.S.), Fondation Rothschild Hospital, Paris, France.
Department of Radiology (W.B., A.B., D.R, D.I., J.R.), Centre Hospitalier de l'Université de Montréal Montréal, Canada.
ORCID: 0000-0001-8120-5128

A Benomar (A)

Department of Radiology (W.B., A.B., D.R, D.I., J.R.), Centre Hospitalier de l'Université de Montréal Montréal, Canada.
ORCID: 0000-0002-3735-1686

C Ducroux (C)

Department of Neurology (C.D., R.F.), Ottawa Hospital Research Institute & University of Ottawa, Ottawa, Canada.
ORCID: 0000-0001-8938-9494

R Fahed (R)

Department of Neurology (C.D., R.F.), Ottawa Hospital Research Institute & University of Ottawa, Ottawa, Canada.
ORCID: 0000-0002-1887-5097

S Smajda (S)

From the Department of Interventional Neuroradiology (W.B., S.S.), Fondation Rothschild Hospital, Paris, France.
ORCID: 0000-0002-6486-1710

J D B Diestro (JDB)

Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D., R.O.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
ORCID: 0000-0001-8450-2021

G Charbonnier (G)

Interventional Neuroradiology Department (G.C.), Besançon University Hospital, Besançon, France.
ORCID: 0000-0002-4425-3849

J Ognard (J)

Interventional Neuroradiology Department (J.O.), Hôpital de la Cavale Blanche, Brest, Bretagne, France.
ORCID: 0000-0003-4495-7464

J Burel (J)

Department of Radiology (J. Burel), Rouen University Hospital, Rouen, France.
ORCID: 0000-0001-8726-265X

A Ter Schiphorst (A)

Neurology Department (A.T.S.), CHRU Gui de Chauliac, Montpellier, France.
ORCID: 0000-0002-7354-3351

M Boulanger (M)

Department of Neurology (M. Boulanger, A.N.), Caen University Hospital, Caen, France.
ORCID: 0000-0003-0900-1766

A Nehme (A)

Department of Neurology (M. Boulanger, A.N.), Caen University Hospital, Caen, France.
ORCID: 0000-0002-7700-6799

J Boucherit (J)

Department of Radiology (J. Boucherit), Rennes University Hospital, Rennes, France.
ORCID: 0009-0000-0824-3128

G Marnat (G)

Department of Neuroradiology (G. Marnat), University Hospital of Bordeaux, Bordeaux, France.
ORCID: 0000-0002-7611-7753

D Volders (D)

From the Department of Interventional Neuroradiology (W.B., S.S.), Fondation Rothschild Hospital, Paris, France.
ORCID: 0000-0003-4074-8702

Q Holay (Q)

Radiology Department (Q.H.), Hôpital d'Instruction des armées Saint-Anne, Toulon, France.
ORCID: 0000-0002-3781-4628

G Forestier (G)

Neuroradiology Department (G.F.), University Hospital of Limoges, Limoges, France.
ORCID: 0000-0003-4797-9693

M Bretzner (M)

Neuroradiology Department (M. Bretzner), CHU Lille, University Lille, Inserm, U1172 Lille Neuroscience & Cognition, F-59000, Lille, France.
ORCID: 0000-0002-7594-4159

D Roy (D)

Department of Radiology (W.B., A.B., D.R, D.I., J.R.), Centre Hospitalier de l'Université de Montréal Montréal, Canada.
ORCID: 0000-0002-6066-4453

S Vingadassalom (S)

Interventional Neuroradiology Department (S.V.), CHRU Marseille, La Timone, France.
ORCID: 0000-0002-8222-5187

M Elhorany (M)

Department of Neuroradiology (M.E.), Groupe Hospitalier de Pitié Salpêtrière, Paris, France.
Department of Neurology (M.E.), Tanta University, Tanta, Egypt.
ORCID: 0000-0002-0257-2040

L Nico (L)

Department of Radiology (L.N.), University Hospital of Padova, Padova, Italy.
ORCID: 0000-0003-2680-8916

G Jacquin (G)

Neurovascular Health Program (G.J.), Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada.
ORCID: 0000-0003-4362-1571

M Abdalkader (M)

Department of Radiology (M.A.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts.
ORCID: 0000-0002-9528-301X

A Guedon (A)

Department of Neuroradiology (A.G.), Lariboisière Hospital, Paris, France.

P Seners (P)

Neurology Department (P.S.), Hôpital Fondation A. de Rothschild, Fondation Rothschild Hospital, Paris, France.
Institut de Psychiatrie et Neurosciences de Paris (P.S.), UMR_S1266, INSERM, Université de Paris, Paris, France.
ORCID: 0000-0002-2134-0691

K Janot (K)

Interventional Neuroradiology (K.J.), University Hospital of Tours, Tours, France.
ORCID: 0000-0002-7305-3125

V Dumas (V)

Radiology Department (V.D.), University Hospital of Poitiers, Poitiers, France.

R Olatunji (R)

Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D., R.O.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
ORCID: 0000-0001-7629-391X

S Gazzola (S)

From the Department of Interventional Neuroradiology (W.B., S.S.), Fondation Rothschild Hospital, Paris, France.
From the Department of Interventional Neuroradiology (W.B., S.S.), Fondation Rothschild Hospital, Paris, France.

G Milot (G)

Department of Radiology (W.B., A.B., D.R, D.I., J.R.), Centre Hospitalier de l'Université de Montréal Montréal, Canada.
Department of Radiology (W.B., A.B., D.R, D.I., J.R.), Centre Hospitalier de l'Université de Montréal Montréal, Canada.

J Zehr (J)

Department of Neurology (C.D., R.F.), Ottawa Hospital Research Institute & University of Ottawa, Ottawa, Canada.
Department of Neurology (C.D., R.F.), Ottawa Hospital Research Institute & University of Ottawa, Ottawa, Canada.

T E Darsaut (TE)

Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D., R.O.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D., R.O.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.

D Iancu (D)

Department of Radiology (W.B., A.B., D.R, D.I., J.R.), Centre Hospitalier de l'Université de Montréal Montréal, Canada.

J Raymond (J)

Department of Radiology (W.B., A.B., D.R, D.I., J.R.), Centre Hospitalier de l'Université de Montréal Montréal, Canada jean.raymond@umontreal.ca.
ORCID: 0000-0003-1978-4274

Classifications MeSH