与神经介入医师在取栓期间改良脑梗死溶栓评分准确性降低相关的因素。
Factors Associated With Decreased Accuracy of Modified Thrombolysis in Cerebral Infarct Scoring Among Neurointerventionalists During Thrombectomy.
机构信息
Department of Neurosurgery, University of South Florida, Tampa (E.P., V.S., W.G., Z.R., M.M.).
Department of Neurosurgery, University at Buffalo, NY (M.W., A.S., K.S., J.D., E.L., C.I.).
出版信息
Stroke. 2021 Nov;52(11):e733-e738. doi: 10.1161/STROKEAHA.120.033372. Epub 2021 Sep 9.
BACKGROUND AND PURPOSE
The modified Thrombolysis in Cerebral Infarct (mTICI) score is used to grade angiographic outcome after endovascular thrombectomy. We sought to identify factors that decrease the accuracy of intraprocedural mTICI.
METHODS
We performed a 2-center retrospective cohort study comparing operator (n=6) mTICI scores to consensus scores from blinded adjudicators. Groups were also assessed by dichotomizing mTICI scores to 0–2a versus 2b–3.
RESULTS
One hundred thirty endovascular thrombectomy procedures were included. Operators and adjudicators had a pairwise agreement in 96 cases (73.8%). Krippendorff α was 0.712. Multivariate analysis showed endovascular thrombectomy overnight (odds ratio [OR]=3.84 [95% CI, 1.22–12.1]), lacking frontal (OR, 5.66 [95 CI, 1.36–23.6]), or occipital (OR, 7.18 [95 CI, 2.12–24.3]) region reperfusion, and higher operator mTICI scores (OR, 2.16 [95 CI, 1.16–4.01]) were predictive of incorrectly scoring mTICI intraprocedurally. With dichotomized mTICI scores, increasing number of passes was associated with increased risk of operator error (OR, 1.93 [95 CI, 1.22–3.05]).
CONCLUSIONS
In our study, mTICI disagreement between operator and adjudicators was observed in 26.2% of cases. Interventions that took place between 22:30 and 4:00, featured frontal or occipital region nonperfusion, higher operator mTICI scores, and increased number of passes had higher odds of intraprocedural mTICI inaccuracy.
背景与目的
改良脑梗死溶栓（mTICI）评分用于评估血管内血栓切除术的血管造影结果。本研究旨在确定降低术中 mTICI 评分准确性的因素。
方法
我们进行了一项 2 中心回顾性队列研究，比较了术者（n=6）mTICI 评分与盲法裁决者的共识评分。还通过将 mTICI 评分分为 0–2a 与 2b–3 来评估两组。
结果
共纳入 130 例血管内血栓切除术。术者与裁决者在 96 例（73.8%）中具有配对一致性。Krippendorff α 为 0.712。多变量分析显示，血管内血栓切除术过夜（比值比[OR] = 3.84[95%CI，1.22–12.1]）、缺乏额（OR，5.66[95CI，1.36–23.6]）或枕部（OR，7.18[95CI，2.12–24.3]）区域再灌注，以及术者较高的 mTICI 评分（OR，2.16[95CI，1.16–4.01]）与术中不正确评分 mTICI 相关。采用二分类 mTICI 评分，通过次数的增加与术者错误的风险增加相关（OR，1.93[95CI，1.22–3.05]）。
结论
在我们的研究中，术者与裁决者之间的 mTICI 存在 26.2%的不一致。22:30 至 4:00 之间进行的干预、额部或枕部区域无灌注、术者 mTICI 评分较高和通过次数增加与术中 mTICI 不准确的可能性更高相关。
Zotero 插件