Operator versus core lab adjudication of reperfusion after endovascular treatment of acute ischemic stroke

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5 Citations (Scopus)

Abstract

Background and Purpose - The modified Treatment In Cerebral Ischemia (mTICI) score is the standard method to quantify the degree of reperfusion after endovascular treatment in acute ischemic stroke. In clinical practice, it is commonly assessed by local operators after the procedure. In clinical trials and registries, mTICI is evaluated by an imaging core lab. The aim of this study was to compare operator mTICI with core lab mTICI scores in patients included in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry.

Methods - All patients with an intracranial carotid or middle cerebral artery occlusion with anteroposterior and lateral digital subtraction angiography runs were included. Operators determined the mTICI score immediately after endovascular treatment. Core lab neuroradiologists were blinded to clinical characteristics and assessed mTICI scores based on pre- and postintervention digital subtraction angiography. The agreement between operator and core lab mTICI scores and their value in the prediction of outcome (score on modified Rankin Scale at 90 days) was determined.

Results - In total, 1130 patients were included. The proportion of agreement between operator and core lab mTICI score was 56% (95% CI, 54%-59%). In 33% (95% CI, 31%-36%), mTICI was overestimated by operators. Operators reported a higher rate of successful reperfusion than the core lab (77% versus 67%; difference 10% [95% CI, 6%-14%]; P<0.001). In 252 (33%) of 763 patients scored as incomplete reperfusion by the core lab (mTICI <3), the local read was mTICI 3. Multivariable logistic regression models containing either core lab scored or operator scored successful reperfusion predicted outcome on the full (C statistic of both models: 0.76) or dichotomized modified Rankin Scale (modified Rankin Scale, 0-2; C statistic of both models: 0.83) equally well.

Conclusions - Operators tend to overestimate the degree of reperfusion compared with the core lab although this does not affect the accuracy of outcome prediction.

Original languageEnglish
Pages (from-to)2376-2382
Number of pages7
JournalStroke
Volume49
Issue number10
DOIs
Publication statusPublished - 1 Oct 2018
Externally publishedYes

Fingerprint

Reperfusion
Brain Ischemia
Stroke
Therapeutics
Digital Subtraction Angiography
Registries
Logistic Models
Middle Cerebral Artery Infarction
Netherlands
Randomized Controlled Trials
Clinical Trials

Keywords

  • UT-Hybrid-D
  • Logistic models
  • Middle cerebral artery
  • Reperfusion
  • Stroke
  • Thrombectomy
  • Infarction

Cite this

@article{e8e5c085833e4593b97f4be2e2422527,
title = "Operator versus core lab adjudication of reperfusion after endovascular treatment of acute ischemic stroke",
abstract = "Background and Purpose - The modified Treatment In Cerebral Ischemia (mTICI) score is the standard method to quantify the degree of reperfusion after endovascular treatment in acute ischemic stroke. In clinical practice, it is commonly assessed by local operators after the procedure. In clinical trials and registries, mTICI is evaluated by an imaging core lab. The aim of this study was to compare operator mTICI with core lab mTICI scores in patients included in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry.Methods - All patients with an intracranial carotid or middle cerebral artery occlusion with anteroposterior and lateral digital subtraction angiography runs were included. Operators determined the mTICI score immediately after endovascular treatment. Core lab neuroradiologists were blinded to clinical characteristics and assessed mTICI scores based on pre- and postintervention digital subtraction angiography. The agreement between operator and core lab mTICI scores and their value in the prediction of outcome (score on modified Rankin Scale at 90 days) was determined.Results - In total, 1130 patients were included. The proportion of agreement between operator and core lab mTICI score was 56{\%} (95{\%} CI, 54{\%}-59{\%}). In 33{\%} (95{\%} CI, 31{\%}-36{\%}), mTICI was overestimated by operators. Operators reported a higher rate of successful reperfusion than the core lab (77{\%} versus 67{\%}; difference 10{\%} [95{\%} CI, 6{\%}-14{\%}]; P<0.001). In 252 (33{\%}) of 763 patients scored as incomplete reperfusion by the core lab (mTICI <3), the local read was mTICI 3. Multivariable logistic regression models containing either core lab scored or operator scored successful reperfusion predicted outcome on the full (C statistic of both models: 0.76) or dichotomized modified Rankin Scale (modified Rankin Scale, 0-2; C statistic of both models: 0.83) equally well.Conclusions - Operators tend to overestimate the degree of reperfusion compared with the core lab although this does not affect the accuracy of outcome prediction.",
keywords = "UT-Hybrid-D, Logistic models, Middle cerebral artery, Reperfusion, Stroke, Thrombectomy, Infarction",
author = "Guang Zhang and Marquering, {Henk A.} and {Van Es}, {Adriaan C.G.M.} and Huaizhang Shi and Dippel, {Diederik W.J.} and {van der Lugt}, Aad and Majoie, {Charles B.L.M.} and Roos, {Yvo B.W.E.M.} and {van Oostenbrugge}, {Robert J.} and {van Zwam}, {Wim H.} and Jelis Boiten and Vos, {Jan Albert} and Jansen, {Ivo G.H.} and Mulder, {Maxim J.H.L.} and Goldhoorn, {Robert Jan B.} and Schonewille, {Wouter J.} and Coutinho, {Jonathan M.} and Wermer, {Marieke J.H.} and {van Walderveen}, {Marianne A.A.} and Julie Staals and Jeannette Hofmeijer and Martens, {Jasper M.} and {Lycklama {\`a} Nijeholt}, {Geert J.} and Bob Roozenbeek and Emmer, {Bart J.} and {de Bruijn}, {Sebastiaan F.} and {van Dijk}, {Lukas C.} and {van der Worp}, {H. Bart} and Lo, {Rob H.} and {Van Dijk}, {Ewoud J.} and Boogaarts, {Hieronymus D.} and {de Kort}, {Paul L.M.} and Peluso, {Jo J.P.} and {van den Berg}, {Jan S.P.} and {Van Hasselt}, {Boudewijn A.A.M.} and Aerden, {Leo A.M.} and Dallinga, {Ren{\'e} J.} and Maarten Uyttenboogaart and Omid Eshghi and Schreuder, {Tobien H.C.M.L.} and Heijboer, {Roel J.J.} and Koos Keizer and Yo, {Lonneke S.F.} and {den Hertog}, {Heleen M.} and Sturm, {Emiel J.C.} and Sprengers, {Marieke E.S.} and Jenniskens, {Sjoerd F.M.} and {van den Berg}, Ren{\'e} and Boers, {Anna M.M.} and P.F.C. Groot",
note = "Lippincott WW deal",
year = "2018",
month = "10",
day = "1",
doi = "10.1161/STROKEAHA.118.022031",
language = "English",
volume = "49",
pages = "2376--2382",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
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}

Operator versus core lab adjudication of reperfusion after endovascular treatment of acute ischemic stroke. /.

In: Stroke, Vol. 49, No. 10, 01.10.2018, p. 2376-2382.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Operator versus core lab adjudication of reperfusion after endovascular treatment of acute ischemic stroke

AU - Zhang, Guang

AU - Marquering, Henk A.

AU - Van Es, Adriaan C.G.M.

AU - Shi, Huaizhang

AU - Dippel, Diederik W.J.

AU - van der Lugt, Aad

AU - Majoie, Charles B.L.M.

AU - Roos, Yvo B.W.E.M.

AU - van Oostenbrugge, Robert J.

AU - van Zwam, Wim H.

AU - Boiten, Jelis

AU - Vos, Jan Albert

AU - Jansen, Ivo G.H.

AU - Mulder, Maxim J.H.L.

AU - Goldhoorn, Robert Jan B.

AU - Schonewille, Wouter J.

AU - Coutinho, Jonathan M.

AU - Wermer, Marieke J.H.

AU - van Walderveen, Marianne A.A.

AU - Staals, Julie

AU - Hofmeijer, Jeannette

AU - Martens, Jasper M.

AU - Lycklama à Nijeholt, Geert J.

AU - Roozenbeek, Bob

AU - Emmer, Bart J.

AU - de Bruijn, Sebastiaan F.

AU - van Dijk, Lukas C.

AU - van der Worp, H. Bart

AU - Lo, Rob H.

AU - Van Dijk, Ewoud J.

AU - Boogaarts, Hieronymus D.

AU - de Kort, Paul L.M.

AU - Peluso, Jo J.P.

AU - van den Berg, Jan S.P.

AU - Van Hasselt, Boudewijn A.A.M.

AU - Aerden, Leo A.M.

AU - Dallinga, René J.

AU - Uyttenboogaart, Maarten

AU - Eshghi, Omid

AU - Schreuder, Tobien H.C.M.L.

AU - Heijboer, Roel J.J.

AU - Keizer, Koos

AU - Yo, Lonneke S.F.

AU - den Hertog, Heleen M.

AU - Sturm, Emiel J.C.

AU - Sprengers, Marieke E.S.

AU - Jenniskens, Sjoerd F.M.

AU - van den Berg, René

AU - Boers, Anna M.M.

AU - Groot, P.F.C.

N1 - Lippincott WW deal

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Background and Purpose - The modified Treatment In Cerebral Ischemia (mTICI) score is the standard method to quantify the degree of reperfusion after endovascular treatment in acute ischemic stroke. In clinical practice, it is commonly assessed by local operators after the procedure. In clinical trials and registries, mTICI is evaluated by an imaging core lab. The aim of this study was to compare operator mTICI with core lab mTICI scores in patients included in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry.Methods - All patients with an intracranial carotid or middle cerebral artery occlusion with anteroposterior and lateral digital subtraction angiography runs were included. Operators determined the mTICI score immediately after endovascular treatment. Core lab neuroradiologists were blinded to clinical characteristics and assessed mTICI scores based on pre- and postintervention digital subtraction angiography. The agreement between operator and core lab mTICI scores and their value in the prediction of outcome (score on modified Rankin Scale at 90 days) was determined.Results - In total, 1130 patients were included. The proportion of agreement between operator and core lab mTICI score was 56% (95% CI, 54%-59%). In 33% (95% CI, 31%-36%), mTICI was overestimated by operators. Operators reported a higher rate of successful reperfusion than the core lab (77% versus 67%; difference 10% [95% CI, 6%-14%]; P<0.001). In 252 (33%) of 763 patients scored as incomplete reperfusion by the core lab (mTICI <3), the local read was mTICI 3. Multivariable logistic regression models containing either core lab scored or operator scored successful reperfusion predicted outcome on the full (C statistic of both models: 0.76) or dichotomized modified Rankin Scale (modified Rankin Scale, 0-2; C statistic of both models: 0.83) equally well.Conclusions - Operators tend to overestimate the degree of reperfusion compared with the core lab although this does not affect the accuracy of outcome prediction.

AB - Background and Purpose - The modified Treatment In Cerebral Ischemia (mTICI) score is the standard method to quantify the degree of reperfusion after endovascular treatment in acute ischemic stroke. In clinical practice, it is commonly assessed by local operators after the procedure. In clinical trials and registries, mTICI is evaluated by an imaging core lab. The aim of this study was to compare operator mTICI with core lab mTICI scores in patients included in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry.Methods - All patients with an intracranial carotid or middle cerebral artery occlusion with anteroposterior and lateral digital subtraction angiography runs were included. Operators determined the mTICI score immediately after endovascular treatment. Core lab neuroradiologists were blinded to clinical characteristics and assessed mTICI scores based on pre- and postintervention digital subtraction angiography. The agreement between operator and core lab mTICI scores and their value in the prediction of outcome (score on modified Rankin Scale at 90 days) was determined.Results - In total, 1130 patients were included. The proportion of agreement between operator and core lab mTICI score was 56% (95% CI, 54%-59%). In 33% (95% CI, 31%-36%), mTICI was overestimated by operators. Operators reported a higher rate of successful reperfusion than the core lab (77% versus 67%; difference 10% [95% CI, 6%-14%]; P<0.001). In 252 (33%) of 763 patients scored as incomplete reperfusion by the core lab (mTICI <3), the local read was mTICI 3. Multivariable logistic regression models containing either core lab scored or operator scored successful reperfusion predicted outcome on the full (C statistic of both models: 0.76) or dichotomized modified Rankin Scale (modified Rankin Scale, 0-2; C statistic of both models: 0.83) equally well.Conclusions - Operators tend to overestimate the degree of reperfusion compared with the core lab although this does not affect the accuracy of outcome prediction.

KW - UT-Hybrid-D

KW - Logistic models

KW - Middle cerebral artery

KW - Reperfusion

KW - Stroke

KW - Thrombectomy

KW - Infarction

UR - http://www.scopus.com/inward/record.url?scp=85055598334&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.118.022031

DO - 10.1161/STROKEAHA.118.022031

M3 - Article

VL - 49

SP - 2376

EP - 2382

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 10

ER -