PT  - JOURNAL ARTICLE
AU  - É. Tollard
AU  - T.E. Darsaut
AU  - F. Bing
AU  - F. Guilbert
AU  - G. Gevry
AU  - J. Raymond
TI  - Outcomes of Endovascular Treatments of Aneurysms: Observer Variability and Implications for Interpreting Case Series and Planning Randomized Trials
AID  - 10.3174/ajnr.A2848
DP  - 2011 Dec 22
TA  - American Journal of Neuroradiology
4099  - http://www.ajnr.org/content/early/2011/12/22/ajnr.A2848.short
4100  - http://www.ajnr.org/content/early/2011/12/22/ajnr.A2848.full
AB  - BACKGROUND AND PURPOSE: Angiographic results are commonly used as a surrogate marker of success of coiling of intracranial aneurysms. Inter- and intraobserver agreement in judging angiographic results remain poorly characterized. Our goal was to offer such an evaluation of a grading scale commonly used to evaluate results of endovascular treatment of aneurysms. MATERIALS AND METHODS: A portfolio of 90 angiographic images from 45 patients selected from the core lab data base of a randomized trial was sent to 12 observers on 2 occasions more than 3 months apart. The variability of a 3-value grading scale used to score angiographic results and of a final judgment regarding the presence of a recurrence was studied using κ statistics. RESULTS: Ten participants responded once and 6 responded twice. Agreement was poor to moderate (κ = 0.28–0.5) for senior and junior observers judging angiographic results immediately or 12–18 months after treatment. Agreement reached a reassuring “substantial” (κ = 0.62) level, with a dichotomous presence-absence of a major recurrence, and intraobserver agreement was better in experienced core lab assessors. CONCLUSIONS: There is an important variability in the assessment of angiographic outcomes of endovascular treatments, rendering comparisons between publications risky, if not invalid. A simple dichotomous judgment can be used as a surrogate outcome in randomized trials designed to assess the value of new endovascular devices. Abbreviations CIconfidence intervalHELPSHydrocoil Endovascular Aneurysm Occlusion and Packing StudyRAruptured aneurysmRCTrandomized controlled trialUAunruptured aneurysm