Article Text
Abstract
Background Limited research exists regarding the impact of neuroimaging on endovascular thrombectomy (EVT) decisions for late-window cases of large vessel occlusion (LVO) stroke.
Objective T0 assess whether perfusion CT imaging: (1) alters the proportion of recommendations for EVT, and (2) enhances the reliability of EVT decision-making compared with non-contrast CT and CT angiography.
Methods We conducted a survey using 30 patients drawn from an institutional database of 3144 acute stroke cases. These were presented to 29 Canadian physicians with and without perfusion imaging. We used non-overlapping 95% confidence intervals and difference in agreement classification as criteria to suggest a difference between the Gwet AC1 statistics (κG).
Results The percentage of EVT recommendations differed by 1.1% with or without perfusion imaging. Individual decisions changed in 21.4% of cases (11.3% against EVT and 10.1% in favor). Inter-rater agreement (κG) among the 29 raters was similar between non-perfusion and perfusion CT neuroimaging (κG=0.487; 95% CI 0.327 to 0.647 and κG=0.552; 95% CI 0.430 to 0.675). The 95% CIs overlapped with moderate agreement in both. Intra-rater agreement exhibited overlapping 95% CIs for all 28 raters. κG was either substantial or excellent (0.81–1) for 71.4% (20/28) of raters in both groups.
Conclusions Despite the minimal difference in overall EVT recommendations with either neuroimaging protocol one in five decisions changed with perfusion imaging. Regarding agreement we found that the use of automated CT perfusion images does not significantly impact the reliability of EVT decisions for patients with late-window LVO.
- Stroke
- Thrombectomy
Data availability statement
Data are available upon reasonable request.
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Data availability statement
Data are available upon reasonable request.
Footnotes
Twitter @dannidiestro, @CMHawkes, @AnassBenomarMD, @AlmekhlafiMa, @IamAvirajD, @kislaykishore9, @nimakashani, @nishita_singh3, @VitorMendesPer1
Contributors All the authors meet the following criteria: 1. Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; 2. Drafting the work or revising it critically for important intellectual content; 3. Final approval of the version to be published; 4. Agreement 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. JBD is the overall guarantor of the study. He accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish
Funding JDBD is a recipient of the Fergus Mills Scholarship of McMaster University for the Clinical Uncertainty in Large Vessel Occlusion (CULVO) study.
Competing interests JWBD: Honoraria from Medtronic. Travel grant fromMicrovention; MAA: Member of the scientific advisory board of Palmera Medical;TRM: Principal of eVasc Neurovascular.
Provenance and peer review Not commissioned; externally peer reviewed.
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