Congruence in evaluat­­ing early ischemic changes us­­ing the ASPECT score between the neurologist and the interventional neuroradiologist in patients with acute cerebral ischemia

Authors: J. Král 1,2;  T. Jonszta 3;  V. Marcián 1,2;  H. Tomášková 2;  M. Bar 1,2
Authors‘ workplace: Neurologická klinika, Komplexní cerebrovaskulární centrum FN Ostrava 1;  Katedra neurologie a psychiatrie, LF OU, Ostrava 2;  Ústav radiodiagnostický, FN Ostrava 3
Published in: Cesk Slov Neurol N 2018; 81(3): 304-307
Category: Original Paper
doi: 10.14735/amcsnn2018304


Mechanical thrombectomy is an effective method in the treatment of acute ischemic stroke with evidence of the occlusion of the large intracranial artery. The main indication criteria for mechanical thrombectomy are acute intracranial arterial occlusion and an ASPECT score ≥ 6 points. The aim of our study was to compare the evaluation of early ischemic changes using the ASPECT score between the interventional neuroradiologist and the general neurologist.

All patients with ischemic stroke admitted within 12 h after the onset of the symptom to the Comprehensive Stroke Center, University Hospital Ostrava from April to October 2015 were enrolled in the study. All patients received a non-contrast brain CT examination which was retrospectively evaluated by the interventional neuroradiologist and the general neurologist.

136 patients were included in the study; 71 women, age 71 ± 13 years and 65 men, age 68 ± 12 years. A total of 64 patients (47%) underwent IVT, and 33 patients (24%) had mechanical thrombectomy. An absolute match in the ASPECT score rating was 64%, unweighted kappa index (κ) was 0.19, and 95% CI was 0.063–0.316. Matching 1–2 points in ASPECT score rating was 90%; κ was 0.19; and 95% was CI 0.133–0.220. Matching 1–6 and 7–10 points in ASPECT score rating was 94%; κ was 0.40; and 95% CI was 0.076–0.731.

In our study, we have shown a slight to fair agreement in assessing the presence of extensive early ischemic changes between the neurologist and the interventional neuroradiologist.

Key words:
ASPECT score – inter-rater variability – early ischemic changes

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers


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