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

Overview

Introduction:
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.

Methods:
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.

Results:
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.

Conclusion:
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


Sources

1. Rha JH, Saver JL. The impact of recanalization on ischemic stroke outcome –  a meta-analysis. Stroke 2007; 38(3): 967– 973. doi: 10.1161/ 01.STR.0000258112.14918.24.

2. Lloyd-Jones D, Adams RJ, Brown TM et al. Heart dis­ease and stroke statistics –  2010 update: a report from the American Heart As­sociation. Circulation 2010; 121(7): e46– e215. doi: 10.1161/ CIRCULATIONAHA.109.192667.

3. Volný O, Krajina A, Bar M et al. Konsenzus a návrh k algoritmu léčby –  mechanická trombectomie u akutního mozkového infarktu. Cesk Slov Neurol N 2016; 79/ 112(1): 100– 110. doi: 10.14735/ amcsn­n2016100.

4. D­­ing D. Endovascular mechanical thrombectomy for acute ischemic stroke: a new standard of care. J Stroke 2015; 17(2): 123– 126. doi: 0.5853/ jos.2015.17.2.123.

5. Goyal M, Menon BK, van Zwam WH et al. Endovascular thrombectomy after large-ves­sel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016; 387(10029): 1723– 1731. doi: 10.1016/ S0140-6736(16)00163-X.

6. Campbell BC, Mitchell PJ, Kleinig TJ et al. Endovascular ther­apy for ischemic stroke with perfusion-imag­­ing selection. N Engl J Med 2015; 372(11): 1009– 1018. doi: 10.1056/ NEJMoa1414792.

7. Goyal M, Demchuk AM, Menon BK et al. Randomized as­ses­sment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015; 372(11): 1019– 1030. doi: 10.1056/ NEJMoa1414905.

8. Saver JL, Goyal M, Bonafe A et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015; 372(24): 2285– 2295. doi: 10.1056/ NEJMoa1415061.

9. Jovin TG, Chamor­ro A, Cobo E et al. Thrombectomy within 8 hours after symp­tom onset in ischemic stroke. N Engl J Med 2015; 372(24): 2296– 2306. doi: 10.1056/ NEJMoa1503780.

10. Menon BK, Campbell BC, Levi C et al. Role of imag­­ing in cur­rent acute ischemic stroke workflow for endovascular ther­apy. Stroke 2015; 46(6): 1453– 1461. doi: 10.1161/ STROKEAHA.

11. Demchuk AM, Menon BK, Goyal M. Compar­­ing ves­sel imaging: noncontrast computed tomography/ computed tomographic angiography should be the new minimum standard in acute disabl­­ing stroke. Stroke 2016; 47(1): 273– 281. doi: 10.1161/ STROKEAHA.115.009171.

12. Volny O, Cimflova P, Kadlecova P et al. Single-phase versus multiphase CT angiography in middle cerebral artery clot detection-benefits for less experienced radiologists and neurologists. J Stroke Cerebrovasc Dis 2017; 26(1): 19– 24. doi: 10.1016/ j.jstrokecerebrovasdis.2016.08.023.

13. Landis JR, Koch GG. An application of hierarchical kappa-type statistics in the as­ses­sment of majority agreement among multiple observers. Biometrics 1977; 33(2): 363– 374.

14. Dušek L, Pavlík T, Koptíková J. Analýza dat v neurologii. VI. Přesnost, spolehlivost a reprodukovatelnost měření u diskrétních dat. Cesk Slov Neurol N 2007; 70/ 103(6): 719– 721.

15. Deipolyia AR, Hambergb LM, Gonzaléza RG et al. Dia­gnostic yield of emergency department arch-to-vertex CT angiography in patients with suspected acute stroke. AJNR Am J Neuroradiol 2015; 36(2): 265– 268. doi: 10.3174/ ajnr.A4112.

16. Wunderlich MT, Goertler M, Postert T et al. Recanalization after thrombolysis: does a recanalization time window exists? Neurology 2007; 68(17): 1364– 1368. doi: 10.1212/ 01.wnl.0000260604.26469.8e.

17. Farzin B, Fahed R, Guilbert F et al. Early CT changes in patients admitted fot thrombectomy –  intrarater and inter­rater agreement. Neurology 2016; 87(3): 249– 256. doi: 10.1212/ WNL.0000000000002860.

18. Jovin TG, Saver JL, Ribo M et al. Dif­fusion-weighted imag­­ing or computerized tomography perfusion as­ses­sment with clinical mismatch in the triage of wake up and late present­­ing strokes undergo­­ing neurointervention with Trevo (DAWN) trial methods. Int J Stroke 2017; 12(6) 641– 652. doi: 10.1177/ 1747493017710341.

19. Škoda O, Herzig R, Mikulík R et al. Klinický standard pro dia­gnostiku a léčbu pa­cientů s ischemickou cévní mozkovou příhodou a s tranzitorní ischemickou atakou –  verze 2016. Cesk Slov Neurol N 2016; 79/ 112(3): 351– 363. doi: 10.14735/ amcsn­n2016351.

20. Wardlaw JM, Dorman PJ, Lewis SC et al. Can stroke physicians and neuroradiologists identify signs of early cerebral infarction on CT? J Neurol Neurosurg Psychiatry 1999; 67(5): 651– 653.

21. Grotta JC, Chiu D, Lu M et al. Agreement and variability in the interpretation of early CT changes in stroke patients qualify­­ing for intravenous rtPA ther­apy. Stroke 1999; 30(8): 1528– 1533.

22. Barber PA, Demchuk AM, Zhang J et al. Validity and reliability of a quantitative computed tomography score in predict­­ing outcome of hyperacute stroke before thrombolytic ther­apy. ASPECTS Study Group. Alberta Stroke Program­me Early CT Score. Lancet 2000, 355(9216): 1670-1674.

23. Pexman JH, Barber PA, Hill MD et al. Use of the Alberta Stroke Program Early CT Score (ASPECTS) for as­ses­s­­ing CT scans in patients with acute stroke. AJNR Am J Neuroradiol 2001; 22(8): 1534– 1542.

24. Coutts SB, Demchuk AM, Barber PA et al. Interobserver variation of ASPECTS in real time. Stroke 2004; 35(5): e103– e105. doi: 10.1161/ 01.STR.0000127082.19473.45.

25. Mikulík R, Václavík D, Sanák D et al. A nationwide study on topography and ef­ficacy of the stroke treatment network in the Czech Republic. J Neurol 2010; 257(1): 31– 37. doi: 10.1007/ s00415-009-5259-3.

26. Herweh C, Ringleb PA, Rauch G et al. Performance of e-ASPECTS software in comparison to that of stroke physicians on as­ses­s­­ing CT scans of acute ischemic stroke patients. Int J Stroke 2016; 11(4): 438–445. doi: 10.1177/ 1747493016632244.

27. Lees KR, Ford GA, Muir KW et al. Thrombolytic ther­apy for acute stroke in the United Kingdom: experience from the safe implementation of thrombolysis in stroke (SITS) register. QJM 2008; 101(11): 863– 869. doi: 10.1093/ qjmed/ hcn102.

28. Bar M, Kral J, Jonszta T et al. Inter­rater variability for CT angiography evaluation between neurologists and neuroradiologist in acute stroke patients. Br J Radiol 2017; 90(1071): 20160670. doi: 10.1259/ bjr.20160670.

29. Gupta AC, Schaefer PW , Chaudhry ZA et al. Interobserver reliability of baseline noncontrast ct Alberta stroke program early ct score for intra-arterial stroke treatment selection. AJNR Am J Neuroradiol 2012; 33(6): 1046-1049. doi: 10.3174/ ajnr.A2942.

Labels
Paediatric neurology Neurosurgery Neurology

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Czech and Slovak Neurology and Neurosurgery

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