Operator Versus Core Lab Adjudication of Reperfusion After Endovascular Treatment of Acute Ischemic Stroke

Guang Zhang*, Kilian M. Treurniet, Ivo G. H. Jansen, Bart J. Emmer, Rene van den Berg, Henk A. Marquering, Maarten Uyttenboogaart, Sjoerd F. M. Jenniskens, Yvo B. W. E. M. Roos, Pieter Jan van Doormaal, Adriaan C. G. M. van Es, Aad van der Lugt, Jan-Albert Vos, Geert J. Lycklama A. Nijeholt, Wim H. van Zwam, Huaizhang Shi, Albert J. Yoo, Diederik W. J. Dippel, Charles B. L. M. Majoie, MR CLEAN Registry Investigators

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Downloads (Pure)


Background and Purpose-The modified Treatment In Cerebral Ischemia (mTICI) score is the standard method to quantify the degree of reperfusion after endovascular treatment in acute ischemic stroke. In clinical practice, it is commonly assessed by local operators after the procedure. In clinical trials and registries, mTICI is evaluated by an imaging core lab. The aim of this study was to compare operator mTICI with core lab mTICI scores in patients included in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry.

Methods-All patients with an intracranial carotid or middle cerebral artery occlusion with anteroposterior and lateral digital subtraction angiography runs were included. Operators determined the mTICI score immediately after endovascular treatment. Core lab neuroradiologists were blinded to clinical characteristics and assessed mTICI scores based on pre- and postintervention digital subtraction angiography. The agreement between operator and core lab mTICI scores and their value in the prediction of outcome (score on modified Rankin Scale at 90 days) was determined.

Results-In total, 1130 patients were included. The proportion of agreement between operator and core lab mTICI score was 56% (95% CI, 54%-59%). In 33% (95% CI, 31%-36%), mTICI was overestimated by operators. Operators reported a higher rate of successful reperfusion than the core lab (77% versus 67%; difference 10% [95% CI, 6%-14%]; P

Conclusions-Operators tend to overestimate the degree of reperfusion compared with the core lab although this does not affect the accuracy of outcome prediction.

Original languageEnglish
Pages (from-to)2376-2382
Number of pages7
Issue number10
Publication statusPublished - Oct 2018


  • infarction, middle cerebral artery
  • logistic models
  • reperfusion
  • stroke
  • thrombectomy

Cite this