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Simulator Training for Endovascular Neurosurgery
Published on: May 6, 2020
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Reliability of the Modified TICI Score among Endovascular Neurosurgeons
D M Heiferman1, N C Pecoraro2, A W Wozniak2
1From the Department of Neurological Surgery (D.M.H., N.C.P., M.R.R., J.C.S.), Clinical Research Office (A.W.W.), Loyola University Stritch School of Medicine and Loyola University Medical Center, Maywood, Illinois daniel@heiferman.com.
AJNR. American Journal of Neuroradiology
|July 29, 2020
Summary
The modified TICI score shows moderate reliability for assessing reperfusion after mechanical thrombectomy. Dichotomizing scores and focusing on specific occlusions improved agreement, suggesting training can enhance reliability.
Area of Science:
- Neurology
- Interventional Radiology
- Medical Imaging
Background:
- The modified TICI (mTICI) score is the standard for evaluating reperfusion post-mechanical thrombectomy.
- Limited research exists on the reliability of the mTICI score.
Purpose of the Study:
- To assess the intra-rater and inter-rater reliability of the mTICI score among endovascular neurosurgeons.
- To evaluate factors influencing mTICI score reliability.
Main Methods:
- Four neurosurgeons rated angiograms from 67 patients at two time points.
- Inter-rater and intra-rater reliability were analyzed using kappa statistics.
- Scores were also analyzed dichotomized (0-2a vs. 2b-3) and by occlusion location.
Main Results:
- Inter-rater reliability was moderate-to-substantial (κ = 0.374-0.703).
- Intra-rater reliability was moderate-to-almost perfect (κ = 0.594-0.81).
- Dichotomized mTICI scores showed improved agreement (inter-rater κ = 0.582, intra-rater κ = 0.632-0.82).
Conclusions:
- The mTICI score is practical but has limitations; dichotomization improves reliability.
- Reliability is highest for M1 and ICA occlusions and decreases for distal/posterior occlusions.
- Inter-rater reliability may improve with time and formal training.
