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Interobserver agreement in scoring angiographic results of basilar artery occlusion stroke therapy

Lookup NU author(s): Professor Phil White


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© 2021 American Society of Neuroradiology. All rights reserved.BACKGROUND AND PURPOSE: The modified TICI Infarction grading system is a metric currently used to evaluate angiographic results of thrombectomy for large-vessel occlusion in ischemic stroke. Originally designed for evaluating MCA territories, it is currently used for other vessel occlusions, including the posterior circulation. We postulate that the modified TICI use for the posterior circulation is not accurate due to the different vascular territories supplied by vertebrobasilar vasculature, making grading more complex. MATERIALS AND METHODS: We collected angiographic results from 30 patients who presented with acute posterior circulation occlusions between 2015 and 2018 and underwent thrombectomy in our institution. Eight observers were asked to evaluate the TICI scores before and after thrombectomy. The multirater statistics were computed using Fleiss k analysis. Further data were collected regarding the potential brain territories at risk and the existence of atherosclerotic disease in the basilar artery. RESULTS: The overall agreement k reached 0.277 (SD, 0.013), which suggests a “fair” agreement among the raters. On average, 45% of observers achieved a high accuracy in predicting brain areas at risk of ischemia. As for the existence of basilar atherosclerotic disease, a high agreement (defined as at least 5 of 6 observers) was seen in 20 of the 30 patients. CONCLUSIONS: Despite TICI being ubiquitous in stroke diagnostics, the high variability of posterior circulation TICI scores calls into question its use in these strokes. Other methods should be developed to assess recanalization in the posterior circulation.

Publication metadata

Author(s): Findler M, Turjman AS, Raymond J, White PM, Sadeh-Gonik U, Taschner CA, Mazighi M, Biondi A, Gory B, Turjman F

Publication type: Article

Publication status: Published

Journal: American Journal of Neuroradiology

Year: 2021

Volume: 42

Issue: 8

Pages: 1458-1463

Print publication date: 01/08/2021

Online publication date: 11/06/2021

Acceptance date: 09/03/2021

ISSN (print): 0195-6108

ISSN (electronic): 1936-959X

Publisher: American Society of Neuroradiology


DOI: 10.3174/ajnr.A7182

PubMed id: 34117020


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