Jildaz Caroff1, Cristian Mihalea2,3, Titien Tuilier4, Xavier Barreau5, Christophe Cognard6, Hubert Desal7, Laurent Pierot8, Armelle Arnoux9, Jacques Moret2,10, Laurent Spelle2,10. 1. Interventional Neuroradiology NEURI Center, Hôpital Bicêtre, 78 rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France. Jildaz.caroff@aphp.fr. 2. Interventional Neuroradiology NEURI Center, Hôpital Bicêtre, 78 rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France. 3. Department of Neurosurgery, Piata Eftimie, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania. 4. Interventional Neuroradiology, Hôpital Henri Mondor, Créteil, France. 5. Interventional Neuroradiology, CHU Hôpital Pellegrin, Bordeaux, France. 6. Interventional Neuroradiology, CHU Hôpital Purpan, Toulouse, France. 7. Interventional Neuroradiology, CHU Hôpital Nord Laennec, Nantes, France. 8. Interventional Neuroradiology, Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France. 9. Statistics Department, Hôpital Bicêtre, Le Kremlin-Bicêtre, France. 10. Université Paris-Sud XI, Faculté de Médecine, Le Kremlin-Bicêtre, France.
Abstract
INTRODUCTION: The Woven EndoBridge (WEB) system is an innovative device under evaluation for its capacity to treat wide-neck bifurcation intracranial aneurysms. The purpose of this study is to evaluate the use of the different occlusion scales available in clinical practice. METHODS: Seven WEB-experienced neurointerventionalists were provided with 30 angiographic follow-up data sets and asked to grade each evaluation point according to the Bicêtre Occlusion Scale Score (BOSS), firstly based on DSA images only then using additional C-Arm VasoCT analysis. This BOSS evaluation was then converted into the WEB Occlusion Scale (WOS) and into a dichotomized scale (complete occlusion or not). To estimate the inter-rater agreement among the seven raters, an overall kappa coefficient [1] and its standard error (SE) were computed. RESULTS: Using the five-grade BOSS, raters showed "moderate" agreement (kappa = 0.56). Using the three-grade WOS, agreement appeared slightly better (kappa = 0.59). Strongest inter-rater agreement was observed with a dichotomized version of the scale (complete occlusion or not), which enabled an "almost perfect" agreement (kappa = 0.88). VasoCT consistently enhanced the agreement particularly with regards depicting intra-WEB residual filling. CONCLUSION: The WOS is a consistent means to angiographically evaluate the WEB device efficiency. But the five-grade BOSS scale allows to identify aneurysm subgroups with differing risks of recurrence and/or rehemorrhage, which needs to be separated especially at the initial phase of evaluation of this innovative device. The additional use of VasoCT allows better inter-rater agreement in evaluating occlusion and specially in depicting intra-WEB persistent filling.
INTRODUCTION: The Woven EndoBridge (WEB) system is an innovative device under evaluation for its capacity to treat wide-neck bifurcation intracranial aneurysms. The purpose of this study is to evaluate the use of the different occlusion scales available in clinical practice. METHODS: Seven WEB-experienced neurointerventionalists were provided with 30 angiographic follow-up data sets and asked to grade each evaluation point according to the Bicêtre Occlusion Scale Score (BOSS), firstly based on DSA images only then using additional C-Arm VasoCT analysis. This BOSS evaluation was then converted into the WEB Occlusion Scale (WOS) and into a dichotomized scale (complete occlusion or not). To estimate the inter-rater agreement among the seven raters, an overall kappa coefficient [1] and its standard error (SE) were computed. RESULTS: Using the five-grade BOSS, raters showed "moderate" agreement (kappa = 0.56). Using the three-grade WOS, agreement appeared slightly better (kappa = 0.59). Strongest inter-rater agreement was observed with a dichotomized version of the scale (complete occlusion or not), which enabled an "almost perfect" agreement (kappa = 0.88). VasoCT consistently enhanced the agreement particularly with regards depicting intra-WEB residual filling. CONCLUSION: The WOS is a consistent means to angiographically evaluate the WEB device efficiency. But the five-grade BOSS scale allows to identify aneurysm subgroups with differing risks of recurrence and/or rehemorrhage, which needs to be separated especially at the initial phase of evaluation of this innovative device. The additional use of VasoCT allows better inter-rater agreement in evaluating occlusion and specially in depicting intra-WEB persistent filling.
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