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

Abstract

Background

Complications following mechanical thrombectomy (MT) are common and impact on clinical outcome. However, unless complication reporting is standardised, there is scope for significant variation in results across multiple centres, potentially undermining both inter and intra unit comparisons and multicentre national quality improvement audit programmes. We therefore sought to achieve consensus amongst interventional neuroradiologists (INRs) in England and Wales for reporting of MT complications as part of national audit.

Methods

We conducted a two-round electronic Delphi survey with initial invitation to forty INR panellists representing each neurointerventional centre in England and Wales with questions covering timing, staffing and mode of data entry, specific MT complications (vessel perforation, intracerebral and subarachnoid haemorrhage, vessel dissection, vasospasm and distal or new territory embolisation) and topics for future content inclusion.

Results

There were 22 and 21 respondents in round one and two, respectively. Consensus was achieved in methods of data entry and in reporting of specific complications (strongly supportive of symptomatic haemorrhagic complication reporting rather than non-clinically relevant changes with clear definitions of when to report distal, new territory embolic or vasospastic complications or arterial dissection). There was also agreement to include tandem lesion, access site and procedural-related physiological complications in future.

Conclusion

In this exercise, we have achieved accordance and developed guidance with an emphasis on reporting of clinically relevant/outcome impacting post-MT complications, which will allow for a better standardised and more meaningful national audit process going forward.