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The Management of Persistent Distal Occlusions after Mechanical Thrombectomy and Thrombolysis: An Inter- and Intrarater Agreement Study.
- Source :
-
AJNR. American journal of neuroradiology [AJNR Am J Neuroradiol] 2024 Feb 22. Date of Electronic Publication: 2024 Feb 22. - Publication Year :
- 2024
- Publisher :
- Ahead of Print
-
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.<br />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.<br />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.<br />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.<br /> (© 2024 by American Journal of Neuroradiology.)
Details
- Language :
- English
- ISSN :
- 1936-959X
- Database :
- MEDLINE
- Journal :
- AJNR. American journal of neuroradiology
- Publication Type :
- Academic Journal
- Accession number :
- 38388684
- Full Text :
- https://doi.org/10.3174/ajnr.A8149