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Operator assessment versus core laboratory adjudication of recanalization following endovascular treatment of acute ischemic stroke: a systematic review and meta-analysis
  1. Mohamed K Ibrahim1,
  2. Mostafa A Shehata1,
  3. Sherief Ghozy1,
  4. Cem Bilgin1,
  5. Mohamed Sobhi Jabal1,
  6. Daniel M Heiferman2,
  7. Ramanathan Kadirvel1,
  8. David F Kallmes1
  1. 1 Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
  1. Correspondence to Dr Mohamed K Ibrahim, Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA; ibrahim.mohamed2{at}


Background Successful recanalization after endovascular thrombectomy serves as the primary endpoint in clinical trials and is a crucial predictor of long-term outcomes. Radiographic outcomes for various interventions have been shown to vary based on the type of interpreter, including the site interventionalist compared with an independent reader.

Objective To compare angiographic outcomes in stroke thrombectomy procedures based on the type of reader.

Methods A systematic literature search was conducted in Medline, EMBASE, Scopus, and Web-of-Science through February 2022. We included primary studies that reported core laboratory-read and operator angiographic outcomes after mechanical thrombectomy for ischemic stroke. Furthermore, study-defined successful recanalization data were collected.

Results Eight studies were included with 4797 patients, 51.2% of whom were male. Four thousand, four hundred and thirty-one patients had core readings, and 4211 had operator readings. Study-defined successful recanalization was significantly higher for operator (84%, 3543/4211) examinations than for core laboratory-read (78.4%, 3476/4431) examinations (p<0.001; OR=1.462, 95% CI 1.175 to 1.819). The modified Thrombolysis in Cerebral Infarction (mTICI) scale score of ≥2 b was higher for operator (85%, 3341/3929) examinations than for core laboratory-read (78.6%, 3107/3952) examinations (p<0.001; OR=1.349, 95% CI 1.071 to 1.701). mTICI 3 was significantly higher for operator (54.6%, 1000/1832) examinations than for core laboratory-read (39.9%, 731/1832) examinations (p<0.001; OR=1.823, 95% CI 1.598 to 2.081).

Conclusion Operator angiographic reads are statistically significantly higher than core laboratory-read readings following stroke thrombectomy, especially for complete recanalization. These differences should be considered when interpreting reports of angiographic outcomes after thrombectomy.

  • Thrombectomy
  • Angiography
  • Intervention
  • Stroke

Data availability statement

Data not included in the article or supplemental Material section is available from the authors upon reasonable request.

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Data availability statement

Data not included in the article or supplemental Material section is available from the authors upon reasonable request.

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  • Contributors All authors contributed to the study design and drafting of the manuscript. The search was completed by MAS, MKI, and CB; screening of articles by MAS, MKI, MSJ, and CB; data extraction by MS and MKI, with quality control by MS and MKI. Statistical analysis was provided by MS and SG. All authors approved the final version of this manuscript to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This study was in part supported by the National Institute Of Neurological Disorders And Stroke of the National Institutes of Health under Award Number R01 NS076491.

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

  • Competing interests DFK has the following conflicts: ownership in Nested Knowledge, Inc., Superior Medical Experts, Inc., Conway Medical LLC; research support from: Microvention, Balt USA, Medtronic. RK reports NIH funding (R01 NS076491, R43 NS110114, and R44 NS107111); is a research consultant for Cerenovus, Insera Therapeutics LLC, Marblehead Medical LLC, Microvention Inc, MIVI Neuroscience Inc, Neurogami Medical Inc, and Triticum Inc; and has stock in Neurosigma Inc (money paid to institution).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.