2B, 2C, or 3

Abstract

Background and Purpose— A score of ≥2B on the modified Thrombolysis in Cerebral Infarction scale is generally regarded as successful reperfusion after endovascular treatment for ischemic stroke. The extended Thrombolysis in Cerebral Infarction (eTICI) includes a 2C grade, which indicates near-perfect reperfusion. We investigated how well the respective eTICI scores of 2B, 2C, and 3 correlate with clinical outcome after endovascular treatment. Methods— We used data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry, a prospective, nationwide registry of endovascular treatment in the Netherlands. We included patients with a proximal intracranial occlusion of the anterior circulation for whom final antero-posterior and lateral digital subtraction angiography imaging was available. Our primary outcome was the distribution on the modified Rankin Scale at 90 days per eTICI grade. We performed (ordinal) logistic regression analyses, using eTICI 2B as reference group, and adjusted for potential confounders. Results— In total, 2807/3637 (77%) patients met the inclusion criteria. Of these, 17% achieved reperfusion grade eTICI 0 to 1, 14% eTICI 2A, 25% eTICI 2B, 12% eTICI 2C, and 32% eTICI 3. Groups differed in terms of age ( P <0.001) and occlusion location ( P <0.01). Procedure times decreased with increasing reperfusion grades. We found a positive association between reperfusion grade and functional outcome, which continued to increase after eTICI 2B (adjusted common odds ratio, 1.22 [95% CI, 0.96–1.57] for eTICI 2C versus 2B; adjusted common odds ratio, 1.33 [95% CI, 1.09–1.62] for eTICI 3 versus 2B). Conclusions— Our results indicate a continuous relationship between reperfusion grade and functional outcome, with eTICI 3 leading to the best outcomes. Although this implies that interventionists should aim for the highest possible reperfusion grade, further research on the optimal strategy is necessary.

Relationship between the degree of recanalization and functional outcome in acute ischemic stroke is mediated by penumbra salvage volume

“…So far, it is well known that increasing reperfusion is directly associated with improved functional outcome [ 20 , 21 ]. A recent analysis of the HERMES data observed the increasing rate of favorable outcome with increasing degree of recanalization [ 21 ].…”

“…A further recent study observed that even in the subgroup of patients with “successful” MT (i.e. mTICI ≥ 2b) the highest possible reperfusion grade should be pursued [ 20 ]. However, both studies did not discuss any pathophysiological reasons regarding the relationship of functional outcome and reperfusion degree.…”

“…Accordingly, the presence of ischemic penumbra (metabolically viable brain tissue that may be salvageable with rapid cerebral blood flow restoration) is the fundamental rationale for reperfusion therapy [ 11 ]. However, the effect of endovascular treatment on functional outcome highly depends on the degree of recanalization as exemplified in previous studies [ 15 , 20 , 21 ]. Recently, a meta-analysis found an incremental association between the degree of recanalization and clinical outcome [ 21 ].…”

Circulating Cytokines and Growth Factors in Acute Cerebral Large Vessel Occlusion—Association with Success of Endovascular Treatment

“…Outside clinical trials, TICI scores lower than 2b are achieved in 28% of LVO patients. 29 Given the impact of reperfusion on functional outcome, 24 30 however, it was stated that the goal of MT should be to achieve even an mTICI result of at least 2c, which therefore was defined as the primary endpoint in our analysis. Consistent with previous reports, patients in whom mTICI 2c/3 could be realized had a higher odds of a favorable functional outcome compared with patients with an mTICI 0–2b in this cohort.…”

Thrombus migration in ischemic stroke due to large vessel occlusion: a question of time

“…1 Evidence shows that complete recanalization (modified Thrombolysis in Cerebral Infarction scale (eTICI) 3) after EVT is superior to successful, but incomplete, recanalization (mTICI 2b/2c) with regard to clinical outcomes. 2 Recently, a phenomenon termed thrombus migration (TM), that is, downstream movement of the occluding thrombus in between initial imaging (computed tomography/magnetic resonance imaging-based angiography (CTA/MRA)) and pretreatment imaging in the angio suite, has attracted interest. TM in large vessel occlusion (LVO) stroke undergoing EVT was associated with reduced likelihood to achieve complete recanalization (mTICI 3) and intravenous thrombolysis (IVT) seemed to be the strongest factor facilitating TM.…”