Use of the ABC/2 method to select patients for thrombectomy after 6 hours of symptom onset

 What the hell is your doctor doing to get you 100% recovered regardless of when you first presented in the hospital?

I don't care that that is a BHAG(Big Hairy Audacious Goal, but leaders tackle such goals. Are you leaders or mice? I already know there are no leaders in our fucking failures of stroke associations.

Use of the ABC/2 method to select patients for thrombectomy after 6 hours of symptom onset

 

View ORCID ProfileWilliam Boisseau, View ORCID ProfileCyril Dargazanli, View ORCID ProfileStanislas Smajda, View ORCID ProfileJean Capron, View ORCID ProfileMichel Piotin, View ORCID ProfileCelina Ducroux, View ORCID ProfileMichel Shamy, View ORCID ProfileDariush Dowlatshahi, View ORCID ProfileRichard I. Aviv, View ORCID ProfileRobert Fahed

First published October 12, 2020, DOI: https://doi.org/10.1212/WNL.0000000000010999

Full PDF

Citation

Permissions

Make Comment

See Comments

Downloads

0

Add to Cart ($39)

• Article
• Info & Disclosures

Abstract

Objective To determine whether the ABC/2 method could accurately and reliably measure infarct volume and guide thrombectomy decision in acute stroke cases presenting with late or unknown onset.

Methods Four physicians who routinely use MRI for acute stroke imaging, blinded to the RAPID results, measured the Diffusion Weighted Imaging (DWI) infarct volume using the ABC/2 method. Measurements with ABC/2 (the index test) were compared with RAPID (the reference standard) to calculate sensitivity, specificity, and accuracy parameters for various volume cut-points. Thrombectomy decisions based on RAPID and raters' measurements using DAWN trial criteria were compared. Inter-rater and intra-rater agreement was measured using kappa statistics.

Results Accuracy with the ABC/2 method was greater than 80% for each rater and each volume cut-point. Interrater and intra-rater agreement was substantial-to-excellent for each volume cut-point. Treatment decisions with ABC/2 volume estimations showed strong inter-rater and intra-rater agreement, and led to similar thrombectomy decisions compared with RAPID in more than 85% of cases.

Conclusion DWI infarct volume measurement using ABC/2 method shows strong accuracy and reliability and may be an acceptable alternative to RAPID software for the application of DAWN criteria for thrombectomy decision-making.

• Received March 30, 2020.
• Accepted in final form August 3, 2020.

• © 2020 American Academy of Neurology