title: Inter-Rater Reliability for Thrombolysis in Cerebral Infarction with TICI 2c Category.
abstract: OBJECTIVE
  Thrombolysis in cerebral infarction (TICI) with 2b/3 (>50% of occluded territory/complete reperfusion) has been regarded as a successful angiographic outcome. To account for near-perfect angiographic results, the category TICI 2c (near-complete reperfusion) has been introduced. As the degree of inter-rater reliability for TICI with 2c category remains poorly studied, we strived to evaluate the agreement among stroke-treating specialists.
  
  
  METHODS
  All consecutive patients, who underwent stent-retriever thrombectomy for acute ischemic stroke in the period between January 2014 and April 2016 at the Department of Neurointerventional Radiology, were analyzed. Digital subtraction angiography (DSA) images were interpreted using previously reported modified TICI score with TICI 2c (near-complete reperfusion). All DSA runs were scored independently by stroke-treating specialist, by consensus of neuroradiologist and stroke neurologist, and by consensus of neurointerventional fellow and attending. Reliability analysis was performed using Krippendorff's alpha (K-alpha).
  
  
  RESULTS
  Sixty-one patients were included into analysis of inter-rater agreement. Mean age was 70 years (SD ± 12), 48% were women, and median admission National Institutes of Health Stroke Scale was 16 (IQR = 12-19). Median admission ASPECTS (Alberta Stroke Program Early CT Score) was 8 (IQR 7-9). Forty patients (65%) received intravenous thrombolysis. Agreement for complete modified TICI scale (compared with consensus of neurointerventional fellow and attending) was as follows: fair for stroke physician (K-alpha .36), moderate for neuroradiologist (K-alpha .48), and moderate for neurointerventional fellow (K-alpha .56). Agreement increased to almost perfect when evaluated by consensus of stroke neurologist and neuroradiologist (K-alpha .82).
  
  
  CONCLUSIONS
  Inter-rater agreement for modified TICI increased to almost perfect when scored by consensus of stroke-treating specialists.
authors.affiliation: International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic; First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic. Electronic address: 214565@mail.muni.cz.
authors.forename: Ondrej
authors.initials: O
authors.lastname: Volny
authors.affiliation: International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic; Department of Medical Imaging, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors.forename: Petra
authors.initials: P
authors.lastname: Cimflova
authors.affiliation: Department of Neurointerventional Radiology, David Geffen School of Medicine, University of California, Los Angeles, California.
authors.forename: Viktor
authors.initials: V
authors.lastname: Szeder
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography / Q000379:methods*; D002544:Cerebral Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072141:Neurologists; D015588:Observer Variation; D010348:Patient Care Team; D011237:Predictive Value of Tests; D000072177:Radiologists; D015203:Reproducibility of Results; D012189:Retrospective Studies; D017131:Thrombectomy; D015912:Thrombolytic Therapy
keywords: Inter-rater reliability; category 2c; mechanical thrombectomy; modified TICI; stroke