The Management of Persistent Distal Occlusions after Mechanical Thrombectomy and Thrombolysis: An Inter- and Intrarater Agreement Study.
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.
Background and purposeThe 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 methodsA 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.ResultsThe 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 ConclusionsIndividuals 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.