TY - JOUR
T1 - Operator assessment versus core laboratory adjudication of recanalization following endovascular treatment of acute ischemic stroke
T2 - A systematic review and meta-analysis
AU - Ibrahim, Mohamed K.
AU - Shehata, Mostafa A.
AU - Ghozy, Sherief
AU - Bilgin, Cem
AU - Jabal, Mohamed Sobhi
AU - Heiferman, Daniel M.
AU - Kadirvel, Ramanathan
AU - Kallmes, David F.
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2022/9/26
Y1 - 2022/9/26
N2 - 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.
AB - 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.
KW - Angiography
KW - Intervention
KW - Stroke
KW - Thrombectomy
UR - http://www.scopus.com/inward/record.url?scp=85142886843&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85142886843&partnerID=8YFLogxK
U2 - 10.1136/jnis-2022-019266
DO - 10.1136/jnis-2022-019266
M3 - Article
C2 - 36163347
AN - SCOPUS:85142886843
SN - 1759-8478
VL - 15
SP - 133
EP - 138
JO - Journal of neurointerventional surgery
JF - Journal of neurointerventional surgery
IS - 2
ER -