Limits...
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.

Show MeSH

Related in: MedlinePlus

Comparisons of imaging characteristics between groups B and A/C (N = 98; exclusion of patients with NIHSS <5 and occlusion of distal M2 segments).(A) MTT-ASPECTS, (B) DWI-ASPECTS, and (C) ASPECTS differences between DWI and MTT.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4048270&req=5

pone-0099261-g002: Comparisons of imaging characteristics between groups B and A/C (N = 98; exclusion of patients with NIHSS <5 and occlusion of distal M2 segments).(A) MTT-ASPECTS, (B) DWI-ASPECTS, and (C) ASPECTS differences between DWI and MTT.

Mentions: In patients (n = 98) excluding those with NIHSS <5 and occlusion of catheter inaccessible M2 and M3 segments, imaging characteristics among groups are shown in Figure 2. Unlike Table 3, group A had a median DWI-ASPECTS of 4 and a median D-M ASPECTS of 1.75. Patients with IAR decision had significantly higher DWI-ASPECTS and D-M ASPECTS (p for the trend, <0.001 for each). In addition, the DWI-ASPECTS and the D-M ASPECTS were significantly different between groups B and C, but not between groups B and A (Figure 2).


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)

Comparisons of imaging characteristics between groups B and A/C (N = 98; exclusion of patients with NIHSS <5 and occlusion of distal M2 segments).(A) MTT-ASPECTS, (B) DWI-ASPECTS, and (C) ASPECTS differences between DWI and MTT.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0099261-g002: Comparisons of imaging characteristics between groups B and A/C (N = 98; exclusion of patients with NIHSS <5 and occlusion of distal M2 segments).(A) MTT-ASPECTS, (B) DWI-ASPECTS, and (C) ASPECTS differences between DWI and MTT.
Mentions: In patients (n = 98) excluding those with NIHSS <5 and occlusion of catheter inaccessible M2 and M3 segments, imaging characteristics among groups are shown in Figure 2. Unlike Table 3, group A had a median DWI-ASPECTS of 4 and a median D-M ASPECTS of 1.75. Patients with IAR decision had significantly higher DWI-ASPECTS and D-M ASPECTS (p for the trend, <0.001 for each). In addition, the DWI-ASPECTS and the D-M ASPECTS were significantly different between groups B and C, but not between groups B and A (Figure 2).

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