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Intravenous thrombolysis and thrombectomy decisions in acute ischemic stroke: An interrater and intrarater agreement study

C. Ducroux 1, 2 R. Fahed 1, 2 N. N. Khoury G. Gevry 2 E. Kalsoum 3 M-A Labeyrie 4 D. Ziegler 2 C. Sauve 2 M. Chagnon 5 T. E. Darsaut J. Raymond 2 Philippe Niclot Alain Ameri Jerome Hodel 6 Jean-Christophe Gentric 7 Francois-Mathias Merrien 8 Aurore Jourdain Francois Rouhart 8 Irina Viakhireva 9 Serge Timsit 8, 10, 11 Frederic Clarencon 12 Silvia Pistocchi 12 Charlotte Rosso 13 Chiara Zavanone 14, 15 Emmanuel Houdart 16 Marc-Antoine Labeyrie 4 Peggy Reiner 17 Benjamin Gory 18, 19 Roberto Riva 20 Norbert Nighoghossian 21, 22, 23 Tae-Hee Cho 24 Laurent Derex 25 Francois Eugene 26 Jean-Christophe Ferré 27, 28 Anthony Le Bras 29 Stephane Vannier 30 Maria Lassalle Cyril Chivot Audrey Arnoux 31 Philippe Alla Jean-Brice Veyrieres Gaultier Marnat 32 Jerome Berge 32 Stephane Olindo 33 Igor Sibon 34 Bertrand Lapergue 35 Adrien Wang 35 Arturo Consoli 35, 18 Federico Di Maria Michael Obadia 36 Candice Sabben 37 Mikael Mazighi 38 Hocine Redjem 1 Michel Piotin 36 William Boisseau 1 Lilia Razlog Raoul Pop 39, 40 Remy Beaujeux 41 Dan Mihoc 40 Sebastian Richter Monica Manisor 40 Valerie Wolff Veronique Quenardelle 42 Lisa Zinchenko Mihaela Diaconu Marion Yger 43 Stephen Delorme 44 Christina Iosif 45 Thierry Moulin 46 Hatem Zekri Francois Lallement Olivier Vercruysse 6 Christanthi Papagiannaki Ozlem Ozkul-Wermester 47 Cyril Dargazanli 38 Vincent Costalat 48 Nicolas Gaillard 38 Caroline Arquizan 38 Mireille Cayrecastel Serge Bracard 18, 19 Anne-Laure Derelle 49 Sebastien Richard 50 Lisa Humbertjean 50 Yann Herve Pascal Favrole 51 Patrick Le Coz Thomas de Brouker Marie-Isabelle Force Serge Akono Serkan Cakmak Alexandru Florea Thibault Lalu Gregory Taurin Duc Long Duong Marie-Laure Chadenat Fernando Pico 52 Remi Allibert Sarah Evain 53 Philippe Tassan Eric Berthier Xavier Ducrocq 54 Matthieu Rigal Marion Boulanger 55
27 Empenn
INSERM - Institut National de la Santé et de la Recherche Médicale, Inria Rennes – Bretagne Atlantique , IRISA-D5 - SIGNAUX ET IMAGES NUMÉRIQUES, ROBOTIQUE
Abstract : Purpose. - We aimed to assess agreement on intravenous tissue-plasminogen activator (IV tPA) and mechanical thrombectomy (MT) management decisions in acute ischemic stroke (AIS) patients. Secondary objectives were to assess agreement on Diffusion-Weighted-Imaging-Alberta-Stroke-Program-EArly-CT-Score (DWI-ASPECTS), and clinicians' willingness to recruit patients in a randomized controlled trial (RCT) comparing medical management with or without MT. Materials and Methods. - Studies assessing agreement of IV tPA and MT were systematically reviewed. An electronic portfolio of 41 AIS patients was sent to randomly selected providers at French stroke centers. Raters were asked 4 questions for each case: (1) What is the DWI-ASPECTS? (2) Would you perform IV tPA? (3) Would you perform MT? (4) Would you include the patient in a RCT comparing standard medical therapy with or without MT? Twenty responders were randomly selected to study intrarater agreement. Agreement was assessed using Fleiss' Kappa statistics. Results. - The review yielded two single center studies involving 2-5 raters, with various results. The electronic survey was answered by 86 physicians (60 vascular neurologists and 26 interventional neuroradiologists). The interrater agreement was moderate for IV tPA treatment decisions (kappa = 0.565 [0.420-0.680]), but only fair for MT (kappa = 0.383 [0.289-0.491]) and for combined treatment decisions (kappa = 0.399 [0.320-0.486]). The intrarater agreement was at least substantial for the majority of raters. The interrater agreement for DWI-ASPECTS was fair (kappa = 0.325 [0.276-0.387]). Physicians were willing to include a mean of 14 +/- 9 patients (33.1% +/- 21.7%) in a RCT. Conclusion. - Disagreements regarding the use of IVtPA or MT in the management of AIS patients remain frequent. Further trials are needed to resolve the numerous areas of uncertainty. (C) 2019 Elsevier Masson SAS. All rights reserved.
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Soumis le : samedi 12 mars 2022 - 16:47:38
Dernière modification le : vendredi 8 avril 2022 - 16:04:03

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C. Ducroux, R. Fahed, N. N. Khoury, G. Gevry, E. Kalsoum, et al.. Intravenous thrombolysis and thrombectomy decisions in acute ischemic stroke: An interrater and intrarater agreement study. Revue Neurologique, Elsevier Masson, 2019, 175 (6), pp.380-389. ⟨10.1016/j.neurol.2018.10.005⟩. ⟨hal-03607023⟩

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