{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T12:49:25Z","timestamp":1791809365331,"version":"4.3.4"},"reference-count":55,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Neurology"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The operational definition and imaging assessment of the no\u2010reflow phenomenon, a potential contributor to poor clinical outcome despite successful thrombectomy, remains debated. We aimed to develop expert\u2010based international consensus on the definition, assessment, and reporting standard of cerebral no\u2010reflow post\u2010thrombectomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Three\u2010rounds of a modified Delphi web\u2010based survey was conducted among corresponding authors of peer\u2010reviewed clinical studies on cerebral no\u2010reflow between 2020 and 2025. Responses at each round were used to develop structured questionnaires for subsequent rounds. Consensus was predefined as \u226565% agreement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 27 panelists, the response rate was 70%, 74%, and 74% over all rounds. There was broad agreement to conceptualize no\u2010reflow as macrovascular recanalization with impaired microvascular reperfusion. Consensus was reached that macrovascular recanalization is ideally assessed as (1) digital subtraction angiography with expanded thrombolysis in cerebral infarction (eTICI) grades 2c without clear distal vessel occlusions and\/or eTICI 3 only, and (2) absence of a wedge\u2010shaped time\u2010to\u2010maximum (Tmax) or time\u2010to\u2010peak (TTP) delay on post\u2010recanalization perfusion computed tomography (CT) or magnetic resonance imaging (MRI). Regarding impaired microvascular reperfusion assessment, cerebral blood flow, and\/or volume were preferred over time\u2010based perfusion parameters (Tmax\/TTP). The panel expressed a preference that no\u2010reflow should ideally be assessed \u22646\u2009hours post\u2010recanalization. Pending formal validation, histopathological\u2013radiological correlation in animal models would sufficiently validate the use of imaging\u2010based definitions in humans.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>Based on currently available literature and expert opinions, this Delphi study provides a framework for systematically reporting cerebral no\u2010reflow after endovascular treatment (EVT). The variability in opinions regarding quantitative thresholds highlights priorities for future methodological standardization and validation studies. ANN NEUROL 2026<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ana.78387","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T12:27:38Z","timestamp":1791808058000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cerebral No\u2010Reflow after Thrombectomy: International Delphi Consensus on Definition and Imaging Assessment"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6839-7134","authenticated-orcid":false,"given":"Adnan","family":"Mujanovic","sequence":"first","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology University Hospital Bern, Inselspital  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Rivet","sequence":"additional","affiliation":[{"name":"Department of Medicine and Neurology Royal Melbourne Hospital, University of Melbourne  Parkville Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrien ter","family":"Schiphorst","sequence":"additional","affiliation":[{"name":"Department of Neurology Montpellier University Hospital  Montpellier France"},{"name":"Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, Universit\u00e9 Paris Cit\u00e9  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5264-2588","authenticated-orcid":false,"given":"Jean\u2010Claude","family":"Baron","sequence":"additional","affiliation":[{"name":"Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, Universit\u00e9 Paris Cit\u00e9  Paris France"},{"name":"Department of Neurology GHU Paris Psychiatrie et Neurosciences, Universit\u00e9 Paris Cit\u00e9  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Kaesmacher","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology University Hospital Bern, Inselspital  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Medicine and Neurology Royal Melbourne Hospital, University of Melbourne  Parkville Australia"},{"name":"Department of Neurology Austin Health  Heidelberg Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Cerebral No\u2010Reflow Delphi\u2010Consensus Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)00163-X"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/svin.121.000257"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000013210"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.124.049574"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/17474930231180434"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/0271678X231209069"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/0271678X20954929"},{"key":"e_1_2_11_9_1","first-page":"437","article-title":"Cerebral ischemia. 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