1
|
Boisseau W, Benomar A, Ducroux C, Fahed R, Smajda S, Diestro JDB, Charbonnier G, Ognard J, Burel J, Ter Schiphorst A, Boulanger M, Nehme A, Boucherit J, Marnat G, Volders D, Holay Q, Forestier G, Bretzner M, Roy D, Vingadassalom S, Elhorany M, Nico L, Jacquin G, Abdalkader M, Guedon A, Seners P, Janot K, Dumas V, Olatunji R, Gazzola S, Milot G, Zehr J, Darsaut TE, Iancu D, Raymond J. The Management of Persistent Distal Occlusions after Mechanical Thrombectomy and Thrombolysis: An Inter- and Intrarater Agreement Study. AJNR Am J Neuroradiol 2024:ajnr.A8149. [PMID: 38388684 DOI: 10.3174/ajnr.a8149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/24/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND AND PURPOSE 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 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 The electronic survey was answered by 31 physicians (8 vascular neurologists and 23 interventional neuroradiologists). Decisions for rescue therapies were more frequent (n = 1116/1860, 60%) than for conservative management (n = 744/1860, 40%; P < .001). Interrater agreement regarding the final management decision was "slight" (κ = 0.12; 95% CI, 0.09-0.14) and did not improve when subgroups of clinicians were studied according to background, experience, and specialty or when cases were grouped according to the level of occlusion. On delayed re-questioning, 23 of 29 respondents (79.3%) disagreed with themselves on at least 20% of cases. Respondents were willing to offer trial participation in 1295 of 1860 (69.6%) cases. 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.
Collapse
Affiliation(s)
- W Boisseau
- 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
| | - A Benomar
- Department of Radiology (W.B., A.B., D.R, D.I., J.R.), Centre Hospitalier de l'Université de Montréal Montréal, Canada
| | - C Ducroux
- Department of Neurology (C.D., R.F.), Ottawa Hospital Research Institute & University of Ottawa, Ottawa, Canada
| | - R Fahed
- Department of Neurology (C.D., R.F.), Ottawa Hospital Research Institute & University of Ottawa, Ottawa, Canada
| | - S Smajda
- From the Department of Interventional Neuroradiology (W.B., S.S.), Fondation Rothschild Hospital, Paris, France
| | - J D B Diestro
- 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
| | - G Charbonnier
- Interventional Neuroradiology Department (G.C.), Besançon University Hospital, Besançon, France
| | - J Ognard
- Interventional Neuroradiology Department (J.O.), Hôpital de la Cavale Blanche, Brest, Bretagne, France
| | - J Burel
- Department of Radiology (J. Burel), Rouen University Hospital, Rouen, France
| | - A Ter Schiphorst
- Neurology Department (A.T.S.), CHRU Gui de Chauliac, Montpellier, France
| | - M Boulanger
- Department of Neurology (M. Boulanger, A.N.), Caen University Hospital, Caen, France
| | - A Nehme
- Department of Neurology (M. Boulanger, A.N.), Caen University Hospital, Caen, France
| | - J Boucherit
- Department of Radiology (J. Boucherit), Rennes University Hospital, Rennes, France
| | - G Marnat
- Department of Neuroradiology (G. Marnat), University Hospital of Bordeaux, Bordeaux, France
| | - D Volders
- From the Department of Interventional Neuroradiology (W.B., S.S.), Fondation Rothschild Hospital, Paris, France
| | - Q Holay
- Radiology Department (Q.H.), Hôpital d'Instruction des armées Saint-Anne, Toulon, France
| | - G Forestier
- Neuroradiology Department (G.F.), University Hospital of Limoges, Limoges, France
| | - M Bretzner
- Neuroradiology Department (M. Bretzner), CHU Lille, University Lille, Inserm, U1172 Lille Neuroscience & Cognition, F-59000, Lille, France
| | - D Roy
- Department of Radiology (W.B., A.B., D.R, D.I., J.R.), Centre Hospitalier de l'Université de Montréal Montréal, Canada
| | - S Vingadassalom
- Interventional Neuroradiology Department (S.V.), CHRU Marseille, La Timone, France
| | - M Elhorany
- Department of Neuroradiology (M.E.), Groupe Hospitalier de Pitié Salpêtrière, Paris, France
- Department of Neurology (M.E.), Tanta University, Tanta, Egypt
| | - L Nico
- Department of Radiology (L.N.), University Hospital of Padova, Padova, Italy
| | - G Jacquin
- Neurovascular Health Program (G.J.), Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - M Abdalkader
- Department of Radiology (M.A.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - A Guedon
- Department of Neuroradiology (A.G.), Lariboisière Hospital, Paris, France
| | - P Seners
- 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
| | - K Janot
- Interventional Neuroradiology (K.J.), University Hospital of Tours, Tours, France
| | - V Dumas
- Radiology Department (V.D.), University Hospital of Poitiers, Poitiers, France
| | - R Olatunji
- 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
| | - S Gazzola
- 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
- 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
- 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
- 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
- Department of Radiology (W.B., A.B., D.R, D.I., J.R.), Centre Hospitalier de l'Université de Montréal Montréal, Canada
| | - J Raymond
- Department of Radiology (W.B., A.B., D.R, D.I., J.R.), Centre Hospitalier de l'Université de Montréal Montréal, Canada
| |
Collapse
|