Intravenous thrombolysis and thrombectomy decisions in acute ischemic stroke: An interrater and intrarater agreement study - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue Revue Neurologique Année : 2019

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

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N. N. Khoury
  • Fonction : Auteur
E. Kalsoum
  • Fonction : Auteur
T. E. Darsaut
  • Fonction : Auteur
Philippe Niclot
  • Fonction : Auteur
Alain Ameri
  • Fonction : Auteur
Jean-Christophe Gentric
Aurore Jourdain
  • Fonction : Auteur
Anthony Le Bras
Maria Lassalle
  • Fonction : Auteur
Cyril Chivot
Audrey Arnoux
  • Fonction : Auteur
  • PersonId : 1146425
  • IdRef : 181221357
Philippe Alla
  • Fonction : Auteur
Jean-Brice Veyrieres
  • Fonction : Auteur
Gaultier Marnat
Jerome Berge
Igor Sibon
Federico Di Maria
  • Fonction : Auteur
Michel Piotin
Lilia Razlog
  • Fonction : Auteur
Sebastian Richter
  • Fonction : Auteur
Valerie Wolff
  • Fonction : Auteur
Lisa Zinchenko
  • Fonction : Auteur
Mihaela Diaconu
  • Fonction : Auteur
Hatem Zekri
  • Fonction : Auteur
Francois Lallement
  • Fonction : Auteur
Christanthi Papagiannaki
  • Fonction : Auteur
Mireille Cayrecastel
  • Fonction : Auteur
Yann Herve
  • Fonction : Auteur
Patrick Le Coz
  • Fonction : Auteur
Thomas de Brouker
  • Fonction : Auteur
Marie-Isabelle Force
  • Fonction : Auteur
Serge Akono
  • Fonction : Auteur
Serkan Cakmak
  • Fonction : Auteur
Alexandru Florea
  • Fonction : Auteur
Thibault Lalu
  • Fonction : Auteur
Gregory Taurin
  • Fonction : Auteur
Duc Long Duong
  • Fonction : Auteur
Marie-Laure Chadenat
  • Fonction : Auteur
Remi Allibert
  • Fonction : Auteur
Philippe Tassan
  • Fonction : Auteur
Eric Berthier
  • Fonction : Auteur
Xavier Ducrocq
  • Fonction : Auteur
  • PersonId : 762030
  • IdRef : 071518347
Matthieu Rigal
  • Fonction : Auteur

Résumé

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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Dates et versions

hal-03607023 , version 1 (12-03-2022)

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Citer

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⟩
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