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.
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Contributors SLZ designed the study, collected the data, wrote the statistical analysis plan, edited the manuscript, and is the guarantor. NL wrote the statistical analysis plan, cleaned the data, and drafted and edited the manuscript. JAM, JV, MS, BA, AMS, AA, ASA, DF, RH, JAH, FKH, RFJ, DFK, PMM, DBN, PR, RDT, and BGW collected the data and edited the manuscript. JM designed the study, collected the data, and edited the manuscript.
Funding This work was supported by Codman & Shurtleff, Inc.
Competing interests ASA is a consultant for Leica, Medtronic, Microvention, Penumbra, Siemens, and Stryker; has received research support from Microvention, Penumbra, and Siemens; and is a shareholder at Bendit, Cerebrotech, Serenity, and Synchron. BGW is a consultant for Stryker and Medtronic. PR is a member of the speaker’s bureau for Stryker Neurovascular; and a shareholder at Perflow Medical and Neurvana Medical. RDT has relationships with Codman, Medtronic, Penumbra, Microvention, Stryker, and Blockade Medical. JM is a consultant for Rebound Medical, Endostream, Synchron, and Cerebrotech; and an investor in Apama, The Stroke Project, Endostream, Synchron, Cerebrotech, NeurVana, and NeuroTechnology Investors.
Ethics approval Institutional review board approval was obtained for the current survey based cross sectional study.
Provenance and peer review Not commissioned; externally peer reviewed.