%0 Journal Article %T Intravenous thrombolysis and thrombectomy decisions in acute ischemic stroke: An interrater and intrarater agreement study %+ Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP] %+ Centre Hospitalier de l'Université de Montréal (CHUM) %+ CHU Henri Mondor [Créteil] %+ Service de Neuroradiologie [CHU Lariboisière] %+ Département de Mathématiques et de statistique [UdeM- Montréal] (DMS) %+ Troubles cognitifs dégénératifs et vasculaires - U 1171 - EA 1046 (TCDV) %+ CIC Brest %+ Service de Neurologie [Brest] %+ Génétique et Physiopathologie des Maladies Cérébro-Vasculaires (U1161 / UMR_S 1161) %+ Centre Hospitalier Régional Universitaire de Brest (CHRU Brest) %+ Génétique, génomique fonctionnelle et biotechnologies (UMR 1078) (GGB) %+ CHU Pitié-Salpêtrière [AP-HP] %+ Institut du Cerveau = Paris Brain Institute (ICM) %+ Sorbonne Université (SU) %+ Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP) %+ Hôpital Lariboisière-Fernand-Widal [APHP] %+ Imagerie Adaptative Diagnostique et Interventionnelle (IADI) %+ Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy) %+ Hospices Civils de Lyon (HCL) %+ Department of Stroke Medicine [Lyon] %+ Université Claude Bernard Lyon 1 (UCBL) %+ Hospices Civils de Lyon, Departement de Neurologie (HCL) %+ Cerebrovascular Unit [Lyon] %+ Health Service and Performance Research (HESPER) %+ Service de radiologie et imagerie médicale [Rennes] = Radiology [Rennes] %+ Neuroimagerie: méthodes et applications (Empenn) %+ Département de Radiologie [CHU de Rennes] %+ Institut de Recherche Technologique b-com (IRT b-com) %+ Service de Neurologie [CHU Rennes] %+ Laboratoire de Psychologie et NeuroCognition (LPNC ) %+ CHU Bordeaux [Bordeaux] %+ Centre Hospitalier Universitaire de Bordeaux (CHU de Bordeaux) %+ Université de Bordeaux (UB) %+ Hôpital Foch [Suresnes] %+ CHU Rothschild [AP-HP] %+ Fondation Ophtalmologique Adolphe de Rothschild [Paris] %+ Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier) %+ L'Institut hospitalo-universitaire de Strasbourg (IHU Strasbourg) %+ Département de Neuroradiologie [Strasbourg] %+ Les Hôpitaux Universitaires de Strasbourg (HUS) %+ Mitochondrie, stress oxydant et protection musculaire (MSP) %+ CHU Saint-Antoine [AP-HP] %+ Centre de Recherche Saint-Antoine (CRSA) %+ Equipe de Recherche Médicale Appliquée (ERMA) %+ Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon) %+ Service de neurologie [Rouen] %+ Département de Neuroradiologie[Montpellier] %+ Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy] %+ Service de neurologie [CHRU Nancy] %+ Service de Neurologie [Aix-en-Provence] %+ Neuroépidémiologie %+ Service de radiologie [Vannes] %+ Centre hospitalier régional Metz-Thionville (CHR Metz-Thionville) %+ Physiopathologie et imagerie des troubles neurologiques (PhIND) %A Ducroux, C. %A Fahed, R. %A Khoury, N. N. %A Gevry, G. %A Kalsoum, E. %A Labeyrie, M-A %A Ziegler, D. %A Sauve, C. %A Chagnon, M. %A Darsaut, T. E. %A Raymond, J. %A Niclot, Philippe %A Ameri, Alain %A Hodel, Jerome %A Gentric, Jean-Christophe %A Merrien, Francois-Mathias %A Jourdain, Aurore %A Rouhart, Francois %A Viakhireva, Irina %A Timsit, Serge %A Clarencon, Frederic %A Pistocchi, Silvia %A Rosso, Charlotte %A Zavanone, Chiara %A Houdart, Emmanuel %A Labeyrie, Marc-Antoine %A Reiner, Peggy %A Gory, Benjamin %A Riva, Roberto %A Nighoghossian, Norbert %A Cho, Tae-Hee %A Derex, Laurent %A Eugene, Francois %A Ferré, Jean-Christophe %A Le Bras, Anthony %A Vannier, Stephane %A Lassalle, Maria %A Chivot, Cyril %A Arnoux, Audrey %A Alla, Philippe %A Veyrieres, Jean-Brice %A Marnat, Gaultier %A Berge, Jerome %A Olindo, Stephane %A Sibon, Igor %A Lapergue, Bertrand %A Wang, Adrien %A Consoli, Arturo %A Di Maria, Federico %A Obadia, Michael %A Sabben, Candice %A Mazighi, Mikael %A Redjem, Hocine %A Piotin, Michel %A Boisseau, William %A Razlog, Lilia %A Pop, Raoul %A Beaujeux, Remy %A Mihoc, Dan %A Richter, Sebastian %A Manisor, Monica %A Wolff, Valerie %A Quenardelle, Veronique %A Zinchenko, Lisa %A Diaconu, Mihaela %A Yger, Marion %A Delorme, Stephen %A Iosif, Christina %A Moulin, Thierry %A Zekri, Hatem %A Lallement, Francois %A Vercruysse, Olivier %A Papagiannaki, Christanthi %A Ozkul-Wermester, Ozlem %A Dargazanli, Cyril %A Costalat, Vincent %A Gaillard, Nicolas %A Arquizan, Caroline %A Cayrecastel, Mireille %A Bracard, Serge %A Derelle, Anne-Laure %A Richard, Sebastien %A Humbertjean, Lisa %A Herve, Yann %A Favrole, Pascal %A Le Coz, Patrick %A de Brouker, Thomas %A Force, Marie-Isabelle %A Akono, Serge %A Cakmak, Serkan %A Florea, Alexandru %A Lalu, Thibault %A Taurin, Gregory %A Duong, Duc Long %A Chadenat, Marie-Laure %A Pico, Fernando %A Allibert, Remi %A Evain, Sarah %A Tassan, Philippe %A Berthier, Eric %A Ducrocq, Xavier %A Rigal, Matthieu %A Boulanger, Marion %< avec comité de lecture %@ 0035-3787 %J Revue Neurologique %I Elsevier Masson %V 175 %N 6 %P 380-389 %8 2019 %D 2019 %R 10.1016/j.neurol.2018.10.005 %M 31047687 %Z Life Sciences [q-bio]Journal articles %X Purpose. - We aimed to assess agreement on intravenous tissue-plasminogen activator (IV tPA) and mechanical thrombectomy (MT) management decisions in acute ischemic stroke (AIS) patients. Secondary objectives were to assess agreement on Diffusion-Weighted-Imaging-Alberta-Stroke-Program-EArly-CT-Score (DWI-ASPECTS), and clinicians' willingness to recruit patients in a randomized controlled trial (RCT) comparing medical management with or without MT. Materials and Methods. - Studies assessing agreement of IV tPA and MT were systematically reviewed. An electronic portfolio of 41 AIS patients was sent to randomly selected providers at French stroke centers. Raters were asked 4 questions for each case: (1) What is the DWI-ASPECTS? (2) Would you perform IV tPA? (3) Would you perform MT? (4) Would you include the patient in a RCT comparing standard medical therapy with or without MT? Twenty responders were randomly selected to study intrarater agreement. Agreement was assessed using Fleiss' Kappa statistics. Results. - The review yielded two single center studies involving 2-5 raters, with various results. The electronic survey was answered by 86 physicians (60 vascular neurologists and 26 interventional neuroradiologists). The interrater agreement was moderate for IV tPA treatment decisions (kappa = 0.565 [0.420-0.680]), but only fair for MT (kappa = 0.383 [0.289-0.491]) and for combined treatment decisions (kappa = 0.399 [0.320-0.486]). The intrarater agreement was at least substantial for the majority of raters. The interrater agreement for DWI-ASPECTS was fair (kappa = 0.325 [0.276-0.387]). Physicians were willing to include a mean of 14 +/- 9 patients (33.1% +/- 21.7%) in a RCT. Conclusion. - Disagreements regarding the use of IVtPA or MT in the management of AIS patients remain frequent. Further trials are needed to resolve the numerous areas of uncertainty. (C) 2019 Elsevier Masson SAS. 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