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<meta name="DC.Title" content="Reliability of the Modified TICI Score among Endovascular Neurosurgeons" />
<meta name="DC.Identifier" content="10.3174/ajnr.A6696" />
<meta name="DC.Date" content="2020-08-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2020 by American Journal of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: The modified TICI score is the benchmark for quantifying reperfusion after mechanical thrombectomy. There has been limited investigation into the reliability of this score. We aim to identify intra-rater and inter-rater reliability of the mTICI score among endovascular neurosurgeons.

MATERIALS AND METHODS: Four independent endovascular neurosurgeons (raters) reviewed angiograms of 67 patients at 2 time points. κ statistics assessed inter- and intrarater reliability and compared raters’-versus-proceduralists’ scores. Reliability was also assessed for occlusion location and by dichotomizing modified TICI scores (0–2a versus 2b–3).

RESULTS: Interrater reliability was moderate-to-substantial, weighted κ = 0.417–0.703, overall κ = 0.374 ( P  &lt; .001). The dichotomized modified TICI score had moderate-to-substantial interrater agreement, κ statistics = 0.468–0.715, overall κ = 0.582 ( P  &lt; .001). Intrarater reliability was moderate-to-almost perfect, weighted κ = 0.594–0.81. The dichotomized modified TICI score had substantial-to-almost perfect reliability, κ = 0.632–0.82. Proceduralists had fair-to-moderate agreement with raters, weighted κ = 0.348–0.574, and the dichotomized modified TICI score had fair-to-moderate agreement, κ = 0.365–0.544. When proceduralists and raters disagreed, proceduralists’ scores were higher in 79.6% of cases. M1 followed by ICA occlusions had the highest agreement.

CONCLUSIONS: The modified TICI score is a practical metric for assessing reperfusion after mechanical thrombectomy, though not without limitations. Agreement improved when scores were dichotomized around the clinically relevant threshold of successful revascularization. Interrater reliability improved with time, suggesting that formal training of interventionalists may improve reporting reliability. Agreement of the modified TICI scale is best with M1 and ICA occlusion and becomes less reliable with more distal or posterior circulation occlusions. These findings should be considered when developing research trials.

mTICI
:   modified TICI
TIMI
:   Thrombolysis in Myocardial Infarction" />
<meta name="DC.Contributor" content="D.M. Heiferman" />
<meta name="DC.Contributor" content="N.C. Pecoraro" />
<meta name="DC.Contributor" content="A.W. Wozniak" />
<meta name="DC.Contributor" content="K.C. Ebersole" />
<meta name="DC.Contributor" content="L.M. Jimenez" />
<meta name="DC.Contributor" content="M.R. Reynolds" />
<meta name="DC.Contributor" content="A.J. Ringer" />
<meta name="DC.Contributor" content="J.C. Serrone" />
<meta name="article:published_time" content="2020-08-01" />
<meta name="article:section" content="Interventional" />
<meta name="citation_title" content="Reliability of the Modified TICI Score among Endovascular Neurosurgeons" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;The modified TICI score is the benchmark for quantifying reperfusion after mechanical thrombectomy. There has been limited investigation into the reliability of this score. We aim to identify intra-rater and inter-rater reliability of the mTICI score among endovascular neurosurgeons.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Four independent endovascular neurosurgeons (raters) reviewed angiograms of 67 patients at 2 time points. κ statistics assessed inter- and intrarater reliability and compared raters’-versus-proceduralists’ scores. Reliability was also assessed for occlusion location and by dichotomizing modified TICI scores (0–2a versus 2b–3).&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Interrater reliability was moderate-to-substantial, weighted κ = 0.417–0.703, overall κ = 0.374 (&lt;i&gt;P &lt;/i&gt;&amp;lt; .001). The dichotomized modified TICI score had moderate-to-substantial interrater agreement, κ statistics = 0.468–0.715, overall κ = 0.582 (&lt;i&gt;P &lt;/i&gt;&amp;lt; .001). Intrarater reliability was moderate-to-almost perfect, weighted κ = 0.594–0.81. The dichotomized modified TICI score had substantial-to-almost perfect reliability, κ = 0.632–0.82. Proceduralists had fair-to-moderate agreement with raters, weighted κ = 0.348–0.574, and the dichotomized modified TICI score had fair-to-moderate agreement, κ = 0.365–0.544. When proceduralists and raters disagreed, proceduralists’ scores were higher in 79.6% of cases. M1 followed by ICA occlusions had the highest agreement.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;The modified TICI score is a practical metric for assessing reperfusion after mechanical thrombectomy, though not without limitations. Agreement improved when scores were dichotomized around the clinically relevant threshold of successful revascularization. Interrater reliability improved with time, suggesting that formal training of interventionalists may improve reporting reliability. Agreement of the modified TICI scale is best with M1 and ICA occlusion and becomes less reliable with more distal or posterior circulation occlusions. These findings should be considered when developing research trials.&lt;/p&gt;" />
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<meta name="twitter:title" content="Reliability of the Modified TICI Score among Endovascular Neurosurgeons" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: The modified TICI score is the benchmark for quantifying reperfusion after mechanical thrombectomy. There has been limited investigation into the reliability of this score. We aim to identify intra-rater and inter-rater reliability of the mTICI score among endovascular neurosurgeons.

MATERIALS AND METHODS: Four independent endovascular neurosurgeons (raters) reviewed angiograms of 67 patients at 2 time points. κ statistics assessed inter- and intrarater reliability and compared raters’-versus-proceduralists’ scores. Reliability was also assessed for occlusion location and by dichotomizing modified TICI scores (0–2a versus 2b–3).

RESULTS: Interrater reliability was moderate-to-substantial, weighted κ = 0.417–0.703, overall κ = 0.374 ( P  &lt; .001). The dichotomized modified TICI score had moderate-to-substantial interrater agreement, κ statistics = 0.468–0.715, overall κ = 0.582 ( P  &lt; .001). Intrarater reliability was moderate-to-almost perfect, weighted κ = 0.594–0.81. The dichotomized modified TICI score had substantial-to-almost perfect reliability, κ = 0.632–0.82. Proceduralists had fair-to-moderate agreement with raters, weighted κ = 0.348–0.574, and the dichotomized modified TICI score had fair-to-moderate agreement, κ = 0.365–0.544. When proceduralists and raters disagreed, proceduralists’ scores were higher in 79.6% of cases. M1 followed by ICA occlusions had the highest agreement.

CONCLUSIONS: The modified TICI score is a practical metric for assessing reperfusion after mechanical thrombectomy, though not without limitations. Agreement improved when scores were dichotomized around the clinically relevant threshold of successful revascularization. Interrater reliability improved with time, suggesting that formal training of interventionalists may improve reporting reliability. Agreement of the modified TICI scale is best with M1 and ICA occlusion and becomes less reliable with more distal or posterior circulation occlusions. These findings should be considered when developing research trials.

mTICI
:   modified TICI
TIMI
:   Thrombolysis in Myocardial Infarction" />
<meta name="og-title" property="og:title" content="Reliability of the Modified TICI Score among Endovascular Neurosurgeons" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/41/8/1441" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: The modified TICI score is the benchmark for quantifying reperfusion after mechanical thrombectomy. There has been limited investigation into the reliability of this score. We aim to identify intra-rater and inter-rater reliability of the mTICI score among endovascular neurosurgeons.

MATERIALS AND METHODS: Four independent endovascular neurosurgeons (raters) reviewed angiograms of 67 patients at 2 time points. κ statistics assessed inter- and intrarater reliability and compared raters’-versus-proceduralists’ scores. Reliability was also assessed for occlusion location and by dichotomizing modified TICI scores (0–2a versus 2b–3).

RESULTS: Interrater reliability was moderate-to-substantial, weighted κ = 0.417–0.703, overall κ = 0.374 ( P  &lt; .001). The dichotomized modified TICI score had moderate-to-substantial interrater agreement, κ statistics = 0.468–0.715, overall κ = 0.582 ( P  &lt; .001). Intrarater reliability was moderate-to-almost perfect, weighted κ = 0.594–0.81. The dichotomized modified TICI score had substantial-to-almost perfect reliability, κ = 0.632–0.82. Proceduralists had fair-to-moderate agreement with raters, weighted κ = 0.348–0.574, and the dichotomized modified TICI score had fair-to-moderate agreement, κ = 0.365–0.544. When proceduralists and raters disagreed, proceduralists’ scores were higher in 79.6% of cases. M1 followed by ICA occlusions had the highest agreement.

CONCLUSIONS: The modified TICI score is a practical metric for assessing reperfusion after mechanical thrombectomy, though not without limitations. Agreement improved when scores were dichotomized around the clinically relevant threshold of successful revascularization. Interrater reliability improved with time, suggesting that formal training of interventionalists may improve reporting reliability. Agreement of the modified TICI scale is best with M1 and ICA occlusion and becomes less reliable with more distal or posterior circulation occlusions. These findings should be considered when developing research trials.

mTICI
:   modified TICI
TIMI
:   Thrombolysis in Myocardial Infarction" />
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      <h1 class="highwire-cite-title" id="page-title">Reliability of the Modified TICI Score among Endovascular Neurosurgeons</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">D.M. Heiferman</span>, <span class="highwire-citation-author" data-delta="1">N.C. Pecoraro</span>, <span class="highwire-citation-author" data-delta="2">A.W. Wozniak</span>, <span class="highwire-citation-author" data-delta="3">K.C. Ebersole</span>, <span class="highwire-citation-author" data-delta="4">L.M. Jimenez</span>, <span class="highwire-citation-author" data-delta="5">M.R. Reynolds</span>, <span class="highwire-citation-author" data-delta="6">A.J. Ringer</span> and <span class="highwire-citation-author" data-delta="7">J.C. Serrone</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">August 2020,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">41 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1441-1446; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A6696 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-77465--6633209104" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">D.M. Heiferman </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From 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</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.M.%2BHeiferman%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Heiferman%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AD.M.%2BHeiferman%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-1302-0655" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for D.M. Heiferman</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">N.C. Pecoraro </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From 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</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=N.C.%2BPecoraro%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Pecoraro%20N&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AN.C.%2BPecoraro%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-4944-9496" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for N.C. Pecoraro</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">A.W. Wozniak </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From 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</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.W.%2BWozniak%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Wozniak%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AA.W.%2BWozniak%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-0670-3677" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A.W. Wozniak</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">K.C. Ebersole </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Neurological Surgery (K.C.E.), University of Kansas Medical Center, Kansas City, Kansas; and Mayfield Brain & Spine (L.M.J., A.J.R.), Cincinnati, Ohio.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=K.C.%2BEbersole%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Ebersole%20K&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AK.C.%2BEbersole%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-3494-6884" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for K.C. Ebersole</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">L.M. Jimenez </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Neurological Surgery (K.C.E.), University of Kansas Medical Center, Kansas City, Kansas; and Mayfield Brain & Spine (L.M.J., A.J.R.), Cincinnati, Ohio.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=L.M.%2BJimenez%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Jimenez%20L&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AL.M.%2BJimenez%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-3233-8076" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for L.M. Jimenez</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">M.R. Reynolds </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From 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</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.R.%2BReynolds%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Reynolds%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.R.%2BReynolds%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-6213-291X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M.R. 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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Aug 2020, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">41 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1441-1446; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A6696 </span></div>
  
  
  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">D.M.</span> <span class="nlm-surname">Heiferman</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">N.C.</span> <span class="nlm-surname">Pecoraro</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">A.W.</span> <span class="nlm-surname">Wozniak</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">K.C.</span> <span class="nlm-surname">Ebersole</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">L.M.</span> <span class="nlm-surname">Jimenez</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">M.R.</span> <span class="nlm-surname">Reynolds</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">A.J.</span> <span class="nlm-surname">Ringer</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">J.C.</span> <span class="nlm-surname">Serrone</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Aug 2020, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">41 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1441-1446; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A6696 </span></div>
  
  
  
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