Standardising mechanical thrombectomy complication reporting: A Delphi consensus study to support guidance for...

Area of Science:

• Neurology
• Interventional Radiology
• Medical Auditing

Background:

• Complications following mechanical thrombectomy (MT) are frequent and affect patient outcomes.
• Inconsistent complication reporting across centers hinders reliable comparisons and national quality improvement audits.
• Standardization is needed for accurate assessment of MT complication rates and impact.

Purpose of the Study:

• To achieve consensus among interventional neuroradiologists (INRs) in England and Wales on standardized reporting of MT complications.
• To establish clear guidelines for reporting specific complications to improve national audit processes.
• To identify key areas for future standardization in MT complication reporting.

Main Methods:

• A two-round electronic Delphi survey was conducted with 40 INRs from neurointerventional centers in England and Wales.
• Survey questions covered data entry methods, specific MT complications (e.g., hemorrhage, dissection, embolization), and future reporting topics.
• Consensus levels were analyzed to determine agreement on reporting standards.

Main Results:

• Consensus was achieved on standardized methods for data entry and reporting of specific MT complications.
• Strong agreement favored reporting symptomatic hemorrhagic complications over non-clinically relevant changes.
• Clear definitions were agreed upon for reporting distal embolization, vasospasm, and arterial dissection.

Conclusions:

• The study successfully developed consensus and guidance for reporting clinically relevant, outcome-impacting post-MT complications.
• The established guidelines will facilitate a more standardized and meaningful national audit process for MT.
• Future efforts will focus on including tandem lesion, access site, and procedural-related physiological complications.