title: To do or not to do; dilemma of intra-arterial revascularization in acute ischemic stroke.
abstract: BACKGROUND
  There has still been lack of evidence for definite imaging criteria of intra-arterial revascularization (IAR). Therefore, IAR selection is left largely to individual clinicians. In this study, we sought to investigate the overall agreement of IAR selection among different stroke clinicians and factors associated with good agreement of IAR selection.
  
  
  METHODS
  From the prospectively registered data base of a tertiary hospital, we identified consecutive patients with acute ischemic stroke. IAR selection based on the provided magnetic resonance imaging (MRI) results and clinical information were independently performed by 5 independent stroke physicians currently working at 4 different university hospitals. MRI results were also reviewed by 2 independent experienced neurologists blinded to clinical data and physicians' IAR selection. The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) was calculated on initial DWI and MTT. We arbitrarily used ASPECTS differences between DWI and MTT (D-M ASPECTS) to quantitatively evaluate mismatch.
  
  
  RESULTS
  The overall interobserver agreement of IAR selection was fair (kappa = 0.398). In patients with DWI-ASPECTS >6, interobserver agreement was moderate to substantial (0.398-0.620). In patients with D-M ASPECTS >4, interobserver agreement was moderate to almost perfect (0.532-1.000). Patients with higher DWI or D-M ASPECTS had better agreement of IAR selection.
  
  
  CONCLUSIONS
  Our study showed that DWI-ASPSECTS >6 and D-M ASPECTS >4 had moderate to substantial agreement of IAR selection among different stroke physicians. However, there is still poor agreement as to whether IAR should not be performed in patients with lower DWI and D-M ASPECTS.
authors.affiliation: Department of Neurology, Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Joon-Tae
authors.initials: JT
authors.lastname: Kim
authors.affiliation: Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
authors.forename: Suk-Hee
authors.initials: SH
authors.lastname: Heo
authors.affiliation: Biostatistical Consulting Unit, Soonchunhyang University Medical Center, Seoul, Korea.
authors.forename: Ji Sung
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Neurology, Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Myeong-Ho
authors.initials: MH
authors.lastname: Park
authors.affiliation: Department of Neurology, Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Dong-Seok
authors.initials: DS
authors.lastname: Oh
authors.affiliation: Department of Neurology, Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Kang-Ho
authors.initials: KH
authors.lastname: Choi
authors.affiliation: Department of Neurology, Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Ihn-Gyu
authors.initials: IG
authors.lastname: Kim
authors.affiliation: Department of Neurology, Wonkwang University Hospital, Iksan, Korea.
authors.forename: Yeon Soo
authors.initials: YS
authors.lastname: Ha
authors.affiliation: Department of Neurology, Wonkwang University Hospital, Iksan, Korea.
authors.forename: Hyuk
authors.initials: H
authors.lastname: Chang
authors.affiliation: Department of Neurology, Chosun University Hospital, Gwangju, Korea.
authors.forename: In Sung
authors.initials: IS
authors.lastname: Choo
authors.affiliation: Department of Neurology, Chosun University Hospital, Gwangju, Korea.
authors.forename: Seong Hwan
authors.initials: SH
authors.lastname: Ahn
authors.affiliation: Department of Neurology, Chonbuk National University Medical School and Hospital, Jeonju, Korea.
authors.forename: Seul-Ki
authors.initials: SK
authors.lastname: Jeong
authors.affiliation: Department of Neurology, Chonbuk National University Medical School and Hospital, Jeonju, Korea.
authors.forename: Byoung-Soo
authors.initials: BS
authors.lastname: Shin
authors.affiliation: Department of Neurology, Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Man-Seok
authors.initials: MS
authors.lastname: Park
authors.affiliation: Department of Neurology, Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Ki-Hyun
authors.initials: KH
authors.lastname: Cho
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000601:surgery; D002533:Cerebral Angiography; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000601:surgery