E-136 What is a challenging clot? A delphi consensus statement from the clot summit group
Notice bibliographique
Résumé
Introduction Research into occlusion factors has substantially increased in recent years, including imaging, flow patterns, clot composition, histology, immunohistochemistry, and biomechanical properties. However, integrating them into clinical practice to identify a challenging occlusion prior to clot retrieval is not well established. Methods A modified DELPHI technique was used before and during CLOT SUMMIT 7.0, which included experts in thrombectomy and clot research from different specialties. Panelists answered three iterative question rounds, in which they indicated their certainty level on the association of 30 specific clot features as indicators for difficult-to-recanalize target occlusions. The features were grouped into 5 domains: histological, imaging, biomechanical, procedural, and clinical factors. The first round included open-ended questions and formed the basis for subsequent rounds, in which closed ended questions were used. Consensus was defined as ≥ 50% agreement among the panelists. Certainty was rated from 1 (‘very uncertain’) to 4 (‘very certain’) in the final round, and mean levels of 3.0 or greater were regarded as high certainty. Results A total of 3 DELPHI rounds were performed, the last two in a live setting. Consensus was reached on 16 out of 30 questions, of which 8 were of high certainty (23%). Except for the clinical factors domain, all others had at last at least one clot feature with consensus and high certainty. Of those, the biomechanical domain produced the most clot features with consensus and high certainty (75%) while the imaging domain produced the least (8.3%). The 8 clot features were combined to produce a holistic definition of a challenging clot: A white coloured or calcified clot that’s stiff, hard, sticky or adherent, that could be calcified on imaging, and during thrombectomy is difficult to pass and resistant to pulling. There was also consensus but with less certainty (2.6/4) that the endovascular (EVT) technique should be switched after the third unsuccessful attempt. Conclusions A live DELPHI consensus from experts in thrombectomy and clot research suggest the features of a challenging clot, which most aptly describe a tough clot: A white coloured or calcified clot that’s stiff, hard, sticky or adherent, that could be calcified on imaging, and during thrombectomy is difficult to pass and resistant to pulling. This may help clinicians and researchers focus on using and developing specialized tools for a priori identification of tough clots for swift recanalization. Disclosures M. Mirza: 5; C; Cerenovus. J. Ospel: None. P. Brouwer: 5; C; Cerenovus.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,039 | 0,085 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,002 | 0,002 |
| Communication savante | 0,003 | 0,003 |
| Science ouverte | 0,001 | 0,006 |
| Intégrité de la recherche | 0,006 | 0,005 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,066 | 0,018 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».