作者
William Boisseau,Anass Benomar,Célina Ducroux,Robert Fahed,Stanislas Smajda,Jose Danilo Bengzon Diestro,Guillaume Charbonnier,Julien Ognard,Julien Burel,Ozlem Ozkul-Wermester,Marion Boulanger,Ahmad Nehme,Julien Boucherit,Gaultier Marnat,David Volders,Quentin Holay,Géraud Forestier,Martin Bretzner,Daniel Roy,Sivadji Vingadassalom,Mahmoud Elhorany,Lorena Nico,Grégory Jacquin,Mohamad Abdalkader,Alexis Guédon,Pierre Seners,Kévin Janot,Víctor Dumas,Richard B. Olatunji,Sébastien Gazzola,Geneviève Milot,J. Zehr,Tim E. Darsaut,Daniela Iancu,Jean Raymond
摘要
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.