Delphi Consensus on Early Neurologic Improvement after Mechanical Thrombectomy.

Area of Science:

• Neurology
• Stroke Medicine
• Clinical Trials

Background:

• Early neurologic improvement (ENI) after mechanical thrombectomy (MT) lacks a standardized definition, hindering clinical practice and research.
• Over 40 different ENI definitions exist, leading to significant heterogeneity and lack of consensus.
• A Delphi study was conducted to investigate expert perspectives on ENI definitions and achieve consensus.

Purpose of the Study:

• To investigate expert perspectives on existing early neurologic improvement (ENI) definitions following mechanical thrombectomy (MT).
• To determine if a consensus can be achieved on a unified ENI definition.
• To identify the key components of a standardized ENI definition for clinical and research applications.

Main Methods:

• A Delphi approach involving 20 neurointerventional experts was employed.
• Systematic literature review followed by three rounds of anonymous web-based surveys.
• Consensus was defined as ≥70% agreement for binary questions and ≥50% for multi-option questions.

Main Results:

• Experts identified definition heterogeneity as a major limitation in using ENI.
• Consensus was reached that a unified ENI definition should predict functional independence at 3 months.
• A unified ENI definition of NIHSS improvement ≥8 points at 24 hours was agreed upon.
• Experts agreed that incorporating comorbidities or baseline severity would complicate the definition.

Conclusions:

• Experts agreed on a unified ENI definition: NIHSS improvement ≥8 points at 24 hours.
• Consensus was not reached on using ENI as a primary endpoint in MT trials.
• Further prospective studies are needed to validate ENI definitions and assess prognostic utility in specific scenarios.