PT  - JOURNAL ARTICLE
AU  - Boisseau, W.
AU  - Benomar, A.
AU  - Ducroux, C.
AU  - Fahed, R.
AU  - Smajda, S.
AU  - Diestro, J. D. B.
AU  - Charbonnier, G.
AU  - Ognard, J.
AU  - Burel, J.
AU  - Ter Schiphorst, A.
AU  - Boulanger, M.
AU  - Nehme, A.
AU  - Boucherit, J.
AU  - Marnat, G.
AU  - Volders, D.
AU  - Holay, Q.
AU  - Forestier, G.
AU  - Bretzner, M.
AU  - Roy, D.
AU  - Vingadassalom, S.
AU  - Elhorany, M.
AU  - Nico, L.
AU  - Jacquin, G.
AU  - Abdalkader, M.
AU  - Guedon, A.
AU  - Seners, P.
AU  - Janot, K.
AU  - Dumas, V.
AU  - Olatunji, R.
AU  - Gazzola, S.
AU  - Milot, G.
AU  - Zehr, J.
AU  - Darsaut, T.E.
AU  - Iancu, D.
AU  - Raymond, J.
TI  - The Management of Persistent Distal Occlusions after Mechanical Thrombectomy and Thrombolysis: An Inter- and Intrarater Agreement Study
AID  - 10.3174/ajnr.A8149
DP  - 2024 Apr 01
TA  - American Journal of Neuroradiology
PG  - 400--405
VI  - 45
IP  - 4
4099  - http://www.ajnr.org/content/45/4/400.short
4100  - http://www.ajnr.org/content/45/4/400.full
SO  - Am. J. Neuroradiol.2024 Apr 01; 45
AB  - 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.CAcontact aspirationIATIntra-arterial thrombolysisIVTIV thrombolysisMTmechanical thrombectomyRCTrandomized controlled trialSRstent retriever