Interobserver agreement after pipeline embolization device implantation

Area of Science:

• Neurology
• Interventional Neuroradiology
• Medical Devices

Background:

• Flow diversion devices are increasingly used for intracranial aneurysm treatment.
• Standardized angiographic assessment and its reliability are crucial for evaluating treatment efficacy.
• Limited studies have assessed interobserver variability in grading outcomes after flow diversion.

Purpose of the Study:

• To evaluate the interobserver agreement of a 3-point grading system for angiographic outcomes after Pipeline embolization device (PED) therapy for saccular intracranial aneurysms.
• To identify factors that may influence agreement in occlusion assessment.

Main Methods:

• Five independent readers assessed pretreatment and follow-up angiograms of 96 patients treated with PED.
• A 3-point grading system (complete, near-complete, incomplete occlusion) was used.
• Interobserver agreement was analyzed using the intraclass correlation coefficient (ICC), with subgroup analysis for previously coiled aneurysms.

Main Results:

• Excellent interobserver agreement was observed (ICC = 0.76).
• Absolute agreement was achieved in 77% of cases; complete occlusion was unanimously agreed upon in 67 cases.
• Major discrepancies (complete vs. incomplete occlusion) occurred in only 7.3% of cases. Minor discrepancies were more frequent in previously coiled aneurysms.

Conclusions:

• The 3-point grading system demonstrates excellent interobserver agreement for assessing angiographic occlusion after PED therapy.
• The Pipeline embolization device (PED) offers reliable outcomes with high consensus among observers.
• The grading system is reliable, with a low rate of significant disagreement, supporting its use in clinical practice and research.