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P142/66  A DELPHI consensus statement on the definition of a tough clot
  1. Mahmood Mirza1,
  2. Johanna Ospel2,
  3. Patrick Brouwer1
  1. 1Cerenovus, Medical Affairs, Galway, Ireland
  2. 2Foothills Medical Centre, University of Calgary, Departments of Diagnostic Imaging and Clinical Neurosciences, Calgary, Canada


Introduction Research into challenging clots in mechanical thrombectomy has substantially increased in recent years, particularly imaging, intra-procedural, and clot properties. However, integrating them to identify a challenging occlusion is not well established.

Aim of Study Explore the opinions of neuro-interventional experts and clot researchers to define these tough clots.

Methods A modified DELPHI technique was used before and live during CLOT SUMMIT 7.0. Panelists answered three iterative question rounds in which they indicated their certainty level from 1 (very uncertain) to 4 (very certain) 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. Consensus was defined as greater than 50% agreement. Certainty levels of 3.0 or greater were regarded as high certainty.

Results After a total of 3 DELPHI rounds, consensus was reached on 16 of 30 questions, where 8 were of high certainty (27%). They were combined to produce a holistic definition of a challenging clot: A clot that could be white colored or calcified, that is stiff, hard, sticky or adherent, with possible calcification visible on imaging, and during thrombectomy is difficult to pass and resistant to pulling.

Conclusion A live DELPHI consensus from experts in thrombectomy and clot research suggest the features of a challenging/tough clot, which may narrow focus for future development of specialized tools for a priori identification of tough clots.

Disclosure of Interest MM and PB are employees of Cerenovus

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