TY - JOUR
T1 - Angiographic results of surgical or endovascular treatment of intracranial aneurysms
T2 - a systematic review and inter-observer reliability study
AU - Benomar, Anass
AU - Farzin, Behzad
AU - Volders, David
AU - Gevry, Guylaine
AU - Zehr, Justine
AU - Fahed, Robert
AU - Boisseau, William
AU - Gentric, Jean Christophe
AU - Magro, Elsa
AU - Nico, Lorena
AU - Roy, Daniel
AU - Weill, Alain
AU - Mounayer, Charbel
AU - Guilbert, François
AU - Létourneau-Guillon, Laurent
AU - Jacquin, Gregory
AU - Chaalala, Chiraz
AU - Kotowski, Marc
AU - Nguyen, Thanh N.
AU - Kallmes, David
AU - White, Phil
AU - Darsaut, Tim E.
AU - Raymond, Jean
N1 - Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.
PY - 2021/9
Y1 - 2021/9
N2 - Purpose: Results of surgical or endovascular treatment of intracranial aneurysms are often assessed using angiography. A reliable method to report results irrespective of treatment modality is needed to enable comparisons. Our goals were to systematically review existing classification systems, and to propose a 3-point classification applicable to both treatments and assess its reliability. Methods: We conducted two systematic reviews on classification systems of angiographic results after clipping or coiling to select a simple 3-category scale that could apply to both treatments. We then circulated an electronic portfolio of angiograms of clipped (n=30) or coiled (n=30) aneurysms, and asked raters to evaluate the degree of occlusion using this scale. Raters were also asked to choose an appropriate follow-up management for each patient based on the degree of occlusion. Agreement was assessed using Krippendorff’s α statistics (αK), and relationship between occlusion grade and clinical management was analyzed using Fisher’s exact and Cramer’s V tests. Results: The systematic reviews found 70 different grading scales with heterogeneous reliability (kappa values from 0.12 to 1.00). The 60-patient portfolio was independently evaluated by 19 raters of diverse backgrounds (neurosurgery, radiology, and neurology) and experience. There was substantial agreement (αK=0.76, 95%CI, 0.67–0.83) between raters, regardless of background, experience, or treatment used. Intra-rater agreement ranged from moderate to almost perfect. A strong relationship was found between angiographic grades and management decisions (Cramer’s V: 0.80±0.12). Conclusion: A simple 3-point scale demonstrated sufficient reliability to be used in reporting aneurysm treatments or in evaluating treatment results in comparative randomized trials.
AB - Purpose: Results of surgical or endovascular treatment of intracranial aneurysms are often assessed using angiography. A reliable method to report results irrespective of treatment modality is needed to enable comparisons. Our goals were to systematically review existing classification systems, and to propose a 3-point classification applicable to both treatments and assess its reliability. Methods: We conducted two systematic reviews on classification systems of angiographic results after clipping or coiling to select a simple 3-category scale that could apply to both treatments. We then circulated an electronic portfolio of angiograms of clipped (n=30) or coiled (n=30) aneurysms, and asked raters to evaluate the degree of occlusion using this scale. Raters were also asked to choose an appropriate follow-up management for each patient based on the degree of occlusion. Agreement was assessed using Krippendorff’s α statistics (αK), and relationship between occlusion grade and clinical management was analyzed using Fisher’s exact and Cramer’s V tests. Results: The systematic reviews found 70 different grading scales with heterogeneous reliability (kappa values from 0.12 to 1.00). The 60-patient portfolio was independently evaluated by 19 raters of diverse backgrounds (neurosurgery, radiology, and neurology) and experience. There was substantial agreement (αK=0.76, 95%CI, 0.67–0.83) between raters, regardless of background, experience, or treatment used. Intra-rater agreement ranged from moderate to almost perfect. A strong relationship was found between angiographic grades and management decisions (Cramer’s V: 0.80±0.12). Conclusion: A simple 3-point scale demonstrated sufficient reliability to be used in reporting aneurysm treatments or in evaluating treatment results in comparative randomized trials.
KW - Classification system
KW - Digital subtraction angiography
KW - Inter-rater reliability
KW - Intracranial aneurysms
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U2 - 10.1007/s00234-021-02676-0
DO - 10.1007/s00234-021-02676-0
M3 - Article
C2 - 33625550
AN - SCOPUS:85101965813
SN - 0028-3940
VL - 63
SP - 1511
EP - 1519
JO - Neuroradiology
JF - Neuroradiology
IS - 9
ER -