M Findler1, A S Turjman2, J Raymond3, P M White4, U Sadeh-Gonik5, C A Taschner6, M Mazighi7, A Biondi8, B Gory9, F Turjman10. 1. Department of Neurology and Interventional Neuroradiology (M.F.), Rabin Medical Center, Petah Tikva, Israel findlerm@gmail.com. 2. Cognition Medical Corporation (Alexis S. Turjman), Boston, Massachusetts. 3. Département de Radiologie, Radio-Oncologie et Médecine Nucléaire (J.R.), Université de Montréal, Montreal, Quebec, Canada. 4. Department of Neuroradiology (P.M.W.), Royal Victoria Infirmary, Newcastle, UK. 5. Department of Radiology and Interventional Neuroradiology (U.S.-G.), Tel Aviv Medical Center, Tel-Aviv, Israel. 6. Department of Neuroradiology (C.A.T.), University Medical Centre Freiburg, Freiburg, Germany. 7. Department of Interventional Neuroradiology (M.M.), Fondation Rothschild Hospital, Paris, France. 8. Department of Neuroradiology and Endovascular Therapy (A.B.), Besancon University Hospital, Besancon, France. 9. Department of Diagnostic and Therapeutic Neuroradiology (B.G.), Centre Hospitalier Régional Universitaire Nancy, Nancy, France. 10. Department of Interventional Neuroradiology (Francis Turjman), Hospices Civils de Lyon, Lyon,France.
Abstract
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 κ 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 κ 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.
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 κ 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 κ 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.
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