Angiographic results of surgical or endovascular treatment of intracranial aneurysms: a systematic review and inter-observer reliability study
- 24 February 2021
- journal article
- review article
- Published by Springer Science and Business Media LLC in Neuroradiology
- Vol. 63 (9), 1511-1519
- https://doi.org/10.1007/s00234-021-02676-0
Abstract
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.Funding Information
- Fonds de Recherche du Québec - Santé (271994)
This publication has 34 references indexed in Scilit:
- International subarachnoid aneurysm trial – ISAT Part II: Study protocol for a randomized controlled trialTrials, 2013
- Outcomes of Endovascular Treatments of Aneurysms: Observer Variability and Implications for Interpreting Case Series and Planning Randomized TrialsAmerican Journal of Neuroradiology, 2011
- Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were proposedJournal of Clinical Epidemiology, 2011
- Scaling Back on Scales with a Scale of ScalesAmerican Journal of Neuroradiology, 2010
- HydroCoil Endovascular Aneurysm Occlusion and Packing Study (HELPS Trial): Procedural Safety and Operator-Assessed Efficacy ResultsAmerican Journal of Neuroradiology, 2008
- Predictors of Rehemorrhage After Treatment of Ruptured Intracranial AneurysmsStroke, 2008
- Long-Term Angiographic Recurrences After Selective Endovascular Treatment of Aneurysms With Detachable CoilsStroke, 2003
- Endovascular Treatment of Unruptured AneurysmsStroke, 2001