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To do or not to do; dilemma of intra-arterial revascularization in acute ischemic stroke.

Kim JT, Heo SH, Lee JS, Park MH, Oh DS, Choi KH, Kim IG, Ha YS, Chang H, Choo IS, Ahn SH, Jeong SK, Shin BS, Park MS, Cho KH - PLoS ONE (2014)

Bottom Line: MRI results were also reviewed by 2 independent experienced neurologists blinded to clinical data and physicians' IAR selection.Patients with higher DWI or D-M ASPECTS had better agreement of IAR selection.However, there is still poor agreement as to whether IAR should not be performed in patients with lower DWI and D-M ASPECTS.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea.

ABSTRACT

Background: There has still been lack of evidence for definite imaging criteria of intra-arterial revascularization (IAR). Therefore, IAR selection is left largely to individual clinicians. In this study, we sought to investigate the overall agreement of IAR selection among different stroke clinicians and factors associated with good agreement of IAR selection.

Methods: From the prospectively registered data base of a tertiary hospital, we identified consecutive patients with acute ischemic stroke. IAR selection based on the provided magnetic resonance imaging (MRI) results and clinical information were independently performed by 5 independent stroke physicians currently working at 4 different university hospitals. MRI results were also reviewed by 2 independent experienced neurologists blinded to clinical data and physicians' IAR selection. The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) was calculated on initial DWI and MTT. We arbitrarily used ASPECTS differences between DWI and MTT (D-M ASPECTS) to quantitatively evaluate mismatch.

Results: The overall interobserver agreement of IAR selection was fair (kappa = 0.398). In patients with DWI-ASPECTS >6, interobserver agreement was moderate to substantial (0.398-0.620). In patients with D-M ASPECTS >4, interobserver agreement was moderate to almost perfect (0.532-1.000). Patients with higher DWI or D-M ASPECTS had better agreement of IAR selection.

Conclusion: Our study showed that DWI-ASPSECTS >6 and D-M ASPECTS >4 had moderate to substantial agreement of IAR selection among different stroke physicians. However, there is still poor agreement as to whether IAR should not be performed in patients with lower DWI and D-M ASPECTS.

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Related in: MedlinePlus

Representative cases of lesion patterns of poor agreements for IAR (A, group B) and lesion patterns with good agreement for IAR decision (B, group C).(A) The figures show moderate sized lesions of right hemisphere on DWI, occlusion of right distal internal carotid artery, and large perfusion deficit on PWI. (B) The figures show small lesion of basal ganglia on DWI, occlusion of right internal carotid artery, and large hemispheric perfusion deficit on PWI.
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pone-0099261-g001: Representative cases of lesion patterns of poor agreements for IAR (A, group B) and lesion patterns with good agreement for IAR decision (B, group C).(A) The figures show moderate sized lesions of right hemisphere on DWI, occlusion of right distal internal carotid artery, and large perfusion deficit on PWI. (B) The figures show small lesion of basal ganglia on DWI, occlusion of right internal carotid artery, and large hemispheric perfusion deficit on PWI.

Mentions: The percentage, mean (±SD), or median (interquartile range, IQR) are presented depending on variable characteristics. Patients were divided into 3 groups according to the proportion of physicians for IAR selection: those on whom none or 1 of the 5 physicians agreed to perform IAR (group A), those on whom 2 or 3 of the 5 physicians agreed to perform IAR (group B, figure 1-A), and those on whom 4 or all of the 5 physicians agreed to perform IAR (group C, figure 1-B). Categorical variables were analyzed using the χ2-test (or Fisher's exact test as appropriate) between individual groups. Continuous variables were analyzed using the independent samples t test (or the Mann–Whitney U test as appropriate) between individual groups and one-way ANOVA test (or Kruskall-Wallis test) between the 3 groups. A p value of <0.05 was considered statistically significant. All of the statistical analyses were performed using SPSS for Windows, version 17 (SPSS Inc., Chicago, IL, USA).


To do or not to do; dilemma of intra-arterial revascularization in acute ischemic stroke.

Kim JT, Heo SH, Lee JS, Park MH, Oh DS, Choi KH, Kim IG, Ha YS, Chang H, Choo IS, Ahn SH, Jeong SK, Shin BS, Park MS, Cho KH - PLoS ONE (2014)

Representative cases of lesion patterns of poor agreements for IAR (A, group B) and lesion patterns with good agreement for IAR decision (B, group C).(A) The figures show moderate sized lesions of right hemisphere on DWI, occlusion of right distal internal carotid artery, and large perfusion deficit on PWI. (B) The figures show small lesion of basal ganglia on DWI, occlusion of right internal carotid artery, and large hemispheric perfusion deficit on PWI.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4048270&req=5

pone-0099261-g001: Representative cases of lesion patterns of poor agreements for IAR (A, group B) and lesion patterns with good agreement for IAR decision (B, group C).(A) The figures show moderate sized lesions of right hemisphere on DWI, occlusion of right distal internal carotid artery, and large perfusion deficit on PWI. (B) The figures show small lesion of basal ganglia on DWI, occlusion of right internal carotid artery, and large hemispheric perfusion deficit on PWI.
Mentions: The percentage, mean (±SD), or median (interquartile range, IQR) are presented depending on variable characteristics. Patients were divided into 3 groups according to the proportion of physicians for IAR selection: those on whom none or 1 of the 5 physicians agreed to perform IAR (group A), those on whom 2 or 3 of the 5 physicians agreed to perform IAR (group B, figure 1-A), and those on whom 4 or all of the 5 physicians agreed to perform IAR (group C, figure 1-B). Categorical variables were analyzed using the χ2-test (or Fisher's exact test as appropriate) between individual groups. Continuous variables were analyzed using the independent samples t test (or the Mann–Whitney U test as appropriate) between individual groups and one-way ANOVA test (or Kruskall-Wallis test) between the 3 groups. A p value of <0.05 was considered statistically significant. All of the statistical analyses were performed using SPSS for Windows, version 17 (SPSS Inc., Chicago, IL, USA).

Bottom Line: MRI results were also reviewed by 2 independent experienced neurologists blinded to clinical data and physicians' IAR selection.Patients with higher DWI or D-M ASPECTS had better agreement of IAR selection.However, there is still poor agreement as to whether IAR should not be performed in patients with lower DWI and D-M ASPECTS.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea.

ABSTRACT

Background: There has still been lack of evidence for definite imaging criteria of intra-arterial revascularization (IAR). Therefore, IAR selection is left largely to individual clinicians. In this study, we sought to investigate the overall agreement of IAR selection among different stroke clinicians and factors associated with good agreement of IAR selection.

Methods: From the prospectively registered data base of a tertiary hospital, we identified consecutive patients with acute ischemic stroke. IAR selection based on the provided magnetic resonance imaging (MRI) results and clinical information were independently performed by 5 independent stroke physicians currently working at 4 different university hospitals. MRI results were also reviewed by 2 independent experienced neurologists blinded to clinical data and physicians' IAR selection. The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) was calculated on initial DWI and MTT. We arbitrarily used ASPECTS differences between DWI and MTT (D-M ASPECTS) to quantitatively evaluate mismatch.

Results: The overall interobserver agreement of IAR selection was fair (kappa = 0.398). In patients with DWI-ASPECTS >6, interobserver agreement was moderate to substantial (0.398-0.620). In patients with D-M ASPECTS >4, interobserver agreement was moderate to almost perfect (0.532-1.000). Patients with higher DWI or D-M ASPECTS had better agreement of IAR selection.

Conclusion: Our study showed that DWI-ASPSECTS >6 and D-M ASPECTS >4 had moderate to substantial agreement of IAR selection among different stroke physicians. However, there is still poor agreement as to whether IAR should not be performed in patients with lower DWI and D-M ASPECTS.

Show MeSH
Related in: MedlinePlus