From the Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, China (G.Z., H.S.).
Departments of Radiology and Nuclear Medicine (G.Z., K.M.T., I.G.H.J., B.J.E., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands.
Stroke. 2018 Oct;49(10):2376-2382. doi: 10.1161/STROKEAHA.118.022031.
Background and Purpose- The modified Treatment In Cerebral Ischemia (mTICI) score is the standard method to quantify the degree of reperfusion after endovascular treatment in acute ischemic stroke. In clinical practice, it is commonly assessed by local operators after the procedure. In clinical trials and registries, mTICI is evaluated by an imaging core lab. The aim of this study was to compare operator mTICI with core lab mTICI scores in patients included in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry. Methods- All patients with an intracranial carotid or middle cerebral artery occlusion with anteroposterior and lateral digital subtraction angiography runs were included. Operators determined the mTICI score immediately after endovascular treatment. Core lab neuroradiologists were blinded to clinical characteristics and assessed mTICI scores based on pre- and postintervention digital subtraction angiography. The agreement between operator and core lab mTICI scores and their value in the prediction of outcome (score on modified Rankin Scale at 90 days) was determined. Results- In total, 1130 patients were included. The proportion of agreement between operator and core lab mTICI score was 56% (95% CI, 54%-59%). In 33% (95% CI, 31%-36%), mTICI was overestimated by operators. Operators reported a higher rate of successful reperfusion than the core lab (77% versus 67%; difference 10% [95% CI, 6%-14%]; P<0.001). In 252 (33%) of 763 patients scored as incomplete reperfusion by the core lab (mTICI <3), the local read was mTICI 3. Multivariable logistic regression models containing either core lab scored or operator scored successful reperfusion predicted outcome on the full (C statistic of both models: 0.76) or dichotomized modified Rankin Scale (modified Rankin Scale, 0-2; C statistic of both models: 0.83) equally well. Conclusions- Operators tend to overestimate the degree of reperfusion compared with the core lab although this does not affect the accuracy of outcome prediction.
背景与目的-改良的治疗急性缺血性脑卒中的脑梗死（mTICI）评分是评估血管内治疗后再灌注程度的标准方法。在临床实践中，通常由当地操作者在手术后进行评估。在临床试验和注册研究中，mTICI 由影像学核心实验室进行评估。本研究旨在比较 MR CLEAN（荷兰多中心急性缺血性卒中血管内治疗临床试验）登记研究中纳入的患者的操作者 mTICI 评分与核心实验室 mTICI 评分。方法-所有接受前后位和侧位数字减影血管造影检查的颅内颈内或大脑中动脉闭塞患者均纳入本研究。操作者在血管内治疗后立即确定 mTICI 评分。核心实验室神经放射学家对临床特征进行盲法评估，并根据治疗前后的数字减影血管造影来评估 mTICI 评分。确定操作者和核心实验室 mTICI 评分之间的一致性及其对预后（90 天改良 Rankin 量表评分）的预测价值。结果-共纳入 1130 例患者。操作者和核心实验室 mTICI 评分的一致性比例为 56%（95%CI，54%-59%）。在 33%（95%CI，31%-36%）的病例中，操作者高估了 mTICI 评分。与核心实验室相比，操作者报告的再灌注成功率更高（77%比 67%；差异 10%[95%CI，6%-14%]；P<0.001）。在 252 例（33%）由核心实验室（mTICI<3）评定为不完全再灌注的 763 例患者中，局部阅读结果为 mTICI 3。包含核心实验室或操作者评定的再灌注成功的多变量逻辑回归模型均能很好地预测完整（两个模型的 C 统计量：0.76）或二分类改良 Rankin 量表（改良 Rankin 量表，0-2；两个模型的 C 统计量：0.83）的结局。结论-尽管这不会影响预后的准确性，但与核心实验室相比，操作者倾向于高估再灌注程度。
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