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. 2021 Sep;63(9):1511-1519.
doi: 10.1007/s00234-021-02676-0. Epub 2021 Feb 24.

Angiographic results of surgical or endovascular treatment of intracranial aneurysms: a systematic review and inter-observer reliability study

Anass Benomar  1 , Behzad Farzin  1 , David Volders  2 , Guylaine Gevry  1 , Justine Zehr  3 , Robert Fahed  4 , William Boisseau  1 , Jean-Christophe Gentric  5 , Elsa Magro  6 , Lorena Nico  7 , Daniel Roy  1 , Alain Weill  1 , Charbel Mounayer  8 , François Guilbert  1 , Laurent Létourneau-Guillon  1 , Gregory Jacquin  9 , Chiraz Chaalala  10 , Marc Kotowski  11 , Thanh N Nguyen  12 , David Kallmes  13 , Phil White  14 , Tim E Darsaut  15 , Jean Raymond  16
Affiliations

Angiographic results of surgical or endovascular treatment of intracranial aneurysms: a systematic review and inter-observer reliability study

Anass Benomar et al. Neuroradiology. 2021 Sep.

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.

Keywords: Classification system; Digital subtraction angiography; Inter-rater reliability; Intracranial aneurysms.

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