Evaluation of previously embolized intracranial aneurysms: inter-and intra-rater reliability among neurosurgeons and interventional neuroradiologists. (16th September 2017)

• Record Type: Journal Article
• Authors: Zuckerman, Scott L; Lakomkin, Nikita; Magarik, Jordan A; Vargas, Jan; Stephens, Marcus; Akinpelu, Babatunde; Spiotta, Alejandro M; Ahmed, Azam; Arthur, Adam S; Fiorella, David; Hanel, Ricardo; Hirsch, Joshua A; Hui, Ferdinand K; James, Robert F; Kallmes, David F; Meyers, Philip M; Niemann, David B; Rasmussen, Peter; Turner, Raymond D; Welch, Babu G; Mocco, J
• Is Part Of: Journal of neurointerventional surgery. Volume 10:Number 5(2018)
• Page Start: 462
• Page End: 466
• Publication Date: 2017-09-16
• Subjects: coil -- aneurysm -- angiography; Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2017-013231
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Background: The angiographic evaluation of previously coiled aneurysms can be difficult yet remains critical for determining re-treatment. Objective: The main objective of this study was to determine the inter-rater reliability for both the Raymond Scale and per cent embolization among a group of neurointerventionalists evaluating previously embolized aneurysms. Methods: A panel of 15 neurointerventionalists examined 92 distinct cases of immediate post-coil embolization and 1 year post-embolization angiographs. Each case was presented four times throughout the study, along with alterations in demographics in order to evaluate intra-rater reliability. All respondents were asked to provide the per cent embolization (0–100%) and Raymond Scale grade (1-3) for each aneurysm. Inter-rater reliability was evaluated by computing weighted kappa values (for the Raymond Scale) and intraclass correlation coefficients (ICC) for per cent embolization. Results: 10 neurosurgeons and 5 interventional neuroradiologists evaluated 368 simulated cases. The agreement among all readers employing the Raymond Scale was fair (κ=0.35) while concordance in per cent embolization was good (ICC=0.64). Clinicians with fewer than 10 years of experience demonstrated a significantly greater level of agreement than the group with greater than 10 years (κ=0.39 and ICC=0.70 vs κ=0.28 and ICC=0.58). When the same aneurysm was presented multiple times, clinicians demonstrated excellent consistency when assessing per cent embolization (ICC=0.82), but moderate agreement when employing the Raymond classification (κ=0.58). Conclusions: Identifying the per cent embolization in previously coiled aneurysms resulted in good inter- and intra-rater agreement, regardless of years of experience. The strong agreement among providers employing per cent embolization may make it a valuable tool for embolization assessment in this patient population.