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)

1 Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP]
2 CHUM - Centre Hospitalier de l'Université de Montréal
3 CHU Henri Mondor
4 Service de Neuroradiologie [CHU Lariboisière]
5 DMS - Département de Mathématiques et de statistique [UdeM- Montréal]
6 TCDV - Troubles cognitifs dégénératifs et vasculaires - U 1171
7 CIC Brest
8 Service de Neurologie [Brest]
9 U1161 / UMR_S 1161 - Génétique et Physiopathologie des Maladies Cérébro-Vasculaires
10 CHRU Brest - Centre Hospitalier Régional Universitaire de Brest
11 GGB - Génétique, génomique fonctionnelle et biotechnologies (UMR 1078)
12 Service de Neuroradiologie [CHU Pitié-Salpêtrière]
13 ICM - Institut du Cerveau = Paris Brain Institute
14 CHU Pitié-Salpêtrière [AP-HP]
15 SU - Sorbonne Université
16 AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)
17 Hôpital Lariboisière-Fernand-Widal [APHP]
18 IADI - Imagerie Adaptative Diagnostique et Interventionnelle
19 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
20 HCL - Hospices Civils de Lyon
21 Department of Stroke Medicine [Lyon]
22 UCBL - Université Claude Bernard Lyon 1
23 HCL - Hospices Civils de Lyon, Departement de Neurologie
24 Cerebrovascular Unit [Lyon]
25 HESPER - Health Service and Performance Research
26 Service de radiologie et imagerie médicale [Rennes] = Radiology [Rennes]
27 Empenn - Neuroimagerie: méthodes et applications
28 Département de Radiologie [CHU de Rennes]
29 IRT b-com - Institut de Recherche Technologique b-com
30 Service de Neurologie [CHU Rennes]
31 LPNC - Laboratoire de Psychologie et NeuroCognition
32 CHU Bordeaux [Bordeaux]
33 CHU de Bordeaux - Centre Hospitalier Universitaire de Bordeaux
34 UB - Université de Bordeaux
35 Hôpital Foch [Suresnes]
36 Hôpital Rothschild [AP-HP]
37 Fondation Ophtalmologique Adolphe de Rothschild [Paris]
38 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
39 IHU Strasbourg - L'Institut hospitalo-universitaire de Strasbourg
40 Département de Neuroradiologie [Strasbourg]
41 Les Hôpitaux Universitaires de Strasbourg (HUS)
42 MSP - Mitochondrie, stress oxydant et protection musculaire
43 Service de Neurologie [CHU Saint-Antoine]
44 CRSA - Centre de Recherche Saint-Antoine
45 ERMA - Equipe de Recherche Médicale Appliquée
46 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
47 Service de neurologie [Rouen]
48 Département de Neuroradiologie[Montpellier]
49 Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy]
50 Service de neurologie [CHRU Nancy]
51 Service de Neurologie [Aix-en-Provence]
52 Neuroépidémiologie
53 Service de radiologie [Vannes]
54 CHR Metz-Thionville - Centre hospitalier régional Metz-Thionville
55 PhIND - Physiopathologie et imagerie des troubles neurologiques

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.

Domaines: Sciences du Vivant [q-bio]

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, 2019, 175 (6), pp.380-389. ⟨10.1016/j.neurol.2018.10.005⟩. ⟨hal-03607023⟩