Impact of Modified TICI 3 versus Modified TICI 2b Reperfusion Score to Predict Good Outcome following Endovascular Therapy

Dargazanli, Cyril; Consoli, Arturo; Barral, Marine; Labreuche, Julien; Redjem, Hocine; Cicciò, Gabriele; Smajda, Stanislas; Desilles, Jean‐Philippe; Taylor, Guillaume; Preda, Cristian; Coskun, Oguzhan; Rodesch, Georges; Piotin, Michel; Blanc, Raphaël; Lapergue, Bertrand

doi:10.3174/ajnr.a4968

Cited by 136 publications

(112 citation statements)

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“…The effects of OTR [5,19], age [6,8], and baseline NIHSS score [8] have been proven and widely accepted as major factors affecting patients' prognosis. Recently, patients achieving mTICI3 reperfusion were reported to have a better functional outcome [20,21]. In the present cohort, complete reperfusion was the strongest positive predictor of a good outcome in the NE group.…”

Section: Discussionsupporting

confidence: 53%

Onset to Reperfusion Time Was Not Important in Mechanical Thrombectomy for Elderly Patients: A Retrospective Multicenter Study in Tama Area, Tokyo

Koizumi¹,

Ota²,

Shigeta³

et al. 2018

Cerebrovasc Dis

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Background: Mechanical thrombectomy (MT) has become the standard of care for acute ischemic stroke with large vessel occlusion; however, evidence remains insufficient for MT for elderly patients, especially with respect to factors affecting their outcomes. Methods: This study was a retrospective analysis of a multicenter registry of MT, called Tama Registry of Acute Endovascular Thrombectomy. Patients were divided by their age into 2 groups: Nonelderly (NE; < 80) and elderly (E; ≥80). Factors related to a good outcome (modified Rankin scale score ≤2) were examined in each group. Onset to reperfusion time (OTR) was stratified into 4 categories: category 1, 0 – ≤180 min; category 2, > 180 – ≤360 min; category 3, > 360 min or onset time not identified; and category 4, effective recanalization not achievable. Results: 143 NE patients and 78 E patients were included in this study. The E group had less chance of achieving a good outcome (NE group 51%, E group 35%; p = 0.024). In the NE group, lower OTR category was an independent prognostic factor for good outcome (p = 0.037, OR = 1.09). However, in the E group, OTR category was not a significant predictor on multivariate analysis. Instead, effective recanalization (p = 0.0081, OR 1.40) and lower National Institute of Health Stroke Scale score at presentation (p = 0.0032, OR 1.02) were the independent predictors. Conclusions: In MT for elderly patients, effective recanalization improved the patients’ outcome but OTR affected less. Further studies are warranted to establish the appropriate patient selection and treatment strategies.

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Section: Discussionsupporting

confidence: 53%

Onset to Reperfusion Time Was Not Important in Mechanical Thrombectomy for Elderly Patients: A Retrospective Multicenter Study in Tama Area, Tokyo

Koizumi¹,

Ota²,

Shigeta³

et al. 2018

Cerebrovasc Dis

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“…Overall, by increasing the degree of reperfusion, better functional outcomes were achieved in AIS harbouring LVO in the anterior circulation [14]. Successful reperfusion was also the main predictor of good functional outcome in our cohort of low NIHSS patients.…”

Section: Discussionmentioning

confidence: 99%

“…Arterial occlusion site, time from symptom onset to groin puncture, procedure time and time to reperfusion were recorded. Reperfusion results were reported by using the modified TICI score and were defined as ranging from no reperfusion (TICI 0) to complete reperfusion (TICI 3), including partial reperfusion (TICI 2) [14]. Collateral arterial supply was assessed using the capillary index score (CIS) [15], and patients were dichotomized into favourable and unfavourable collateral flow groups (CIS 2 or 3 and CIS 0-1, respectively).…”

Section: Methodsmentioning

confidence: 99%

Is Reperfusion Useful in Ischaemic Stroke Patients Presenting with a Low National Institutes of Health Stroke Scale and a Proximal Large Vessel Occlusion of the Anterior Circulation?

et al. 2017

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Background: In population-based studies, patients presenting with minor or mild stroke symptoms represent about two-thirds of stroke patients, and almost one-third of these patients are unable to ambulate independently at the time of discharge. Although mechanical thrombectomy (MT) has become the standard of care for acute ischaemic stroke with proximal large vessel occlusion (LVO) in the anterior circulation, the management of patients harbouring proximal occlusion and minor-to-mild stroke symptoms has not yet been determined by recent trials. The purpose of this study was to evaluate the impact of reperfusion on clinical outcome in low National Institutes of Health Stroke Scale (NIHSS) patients treated with MT. Methods: We analysed 138 consecutive patients with acute LVO of the anterior circulation (middle cerebral artery M1 or M2 segment, internal carotid artery or tandem occlusion) with NIHSS <8, having undergone MT in 3 different centres. Reperfusion was graded using the modified thrombolysis in cerebral infarction (TICI) score and 3 grades were defined, ranging from failed or poor reperfusion (TICI 0, 1, 2A) to complete reperfusion (TICI 3). The primary clinical endpoint was an excellent outcome defined as a modified Rankin score (mRs) 0-1 at 3-months. The impact of reperfusion grade was assessed in univariate and multivariate analyses. The secondary endpoints included favourable functional outcome (90-day mRS 0-2), death and safety concerns. Results: Successful reperfusion was achieved in 81.2% of patients (TICI 2B, n = 47; TICI 3, n = 65). Excellent outcome (mRs 0-1) was achieved in 69 patients (65.0%) and favourable outcome (mRs ≤2) in 108 (78.3%). Death occurred in 7 (5.1%). Excellent outcome increased with reperfusion grades, with a rate of 34.6% in patients with failed/poor reperfusion, 61.7% in patients with TICI 2B reperfusion, and 78.5% in patients with TICI 3 reperfusion (p < 0.001). In multivariate analysis adjusted for patient characteristics associated with excellent outcome, the reperfusion grade remained significantly associated with an increase in excellent outcome; the OR (95% CI) was 3.09 (1.06-9.03) for TICI 2B and 6.66 (2.27-19.48) for TICI 3, using the failed/poor reperfusion grade as reference. Similar results were found regarding favourable outcome (90-day mRs 0-2) or overall mRS distribution (shift analysis). Conclusion: Successful reperfusion is strongly associated with better functional outcome among patients with proximal LVO in the anterior circulation and minor-to-mild stroke symptoms. Randomized controlled studies are mandatory to assess the benefit of MT compared with optimal medical management in this subset of patients.

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“…The clinical use, prognostic value, limitations and potential future developments will be addressed. (6,7,11,16) Imaging Findings OR Procedure Details: mTICI is a tool used to describe the success of reperfusion of the target vascular bed associated with the target occlusive lesion. It is graded from 0 (no reperfusion) to 3 (complete reperfusion) on the pre and post-procedure angiogram.…”

Section: Discussionmentioning

confidence: 99%

“…Number of brain metastases was solitary (101), 2-4 (54) and 5-10 (11). Tumour sub-sites included Non-Small Cell Lung Cancer (63), Melanoma (28), Breast (25), Colorectal (18), Renal (16) and others (16). Initial management for lesions included surgery alone (28), surgery followed by fractionated cavity RT (74), Stereotactic Radiosurgery (SRS) (47), focal Volumetric Modulated Arc Therapy (VMAT) (26) and systemic targeted therapy alone (13).…”

Section: Methodsmentioning

confidence: 99%

Thursday 19 October 2017

2017

J Med Imag Rad Onc

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Artificial intelligence (AI) is already transforming many aspects of our lives and clinicians stand at the brink of a revolution in the way healthcare is delivered. We don't yet know how this will unfold in clinical imaging, but it could eventually see machines autonomously interpreting images and integrating vast genetic and biochemical datasets for precision management of each patient. The radiology community has always been at the forefront of new technology -but the AI revolution could fundamentally change how clinical imaging is delivered. The Media have driven inflated expectations for the speed and success of AI in medicine and the future is probably more nuanced than we expect. In this talk the challenges and opportunities of using "Big Data" and AI in clinical radiology will be discussed as well as a vision for how machines and radiologists may interact in the future. R EhmanMayo Clinic, Rochester, Minnesota, USA Introduction: Hepatic fibrosis is an excessive accumulation of proteins, particularly collagen, in the extracellular matrix of the liver, resulting from chronic inflammation and cellular injury. Hepatic fibrosis alone does not affect liver morphology unless it causes extensive hepatocellular necrosis or scarring and cirrhosis. Conventional MR imaging may show surface nodularity, regenerative nodules, expanded hilar and gallbladder fossa spaces, liver volume changes, and evidence of portal hypertension in advanced liver fibrosis. All of these are signs of advanced disease and morphologic imaging is not sensitive for detecting less than stage 4 fibrosis. MRI-based tissue characterization biomarkers that have proposed for assessing liver fibrosis include measurement of the apparent diffusion coefficient, (ADC), measurement of T1 or T1rho, and quantitative texture analysis without or with contrast material. Statistically significant changes from normal values have been demonstrated with all of these biomarkers advanced fibrosis is present. Like morphologic imaging, these biomarkers have not proved to be sensitive or specific for assessing fibrosis that is less than stage 4. It has long been known that fibrotic liver tissue is mechanically stiffer than normal liver and the degree of increased stiffness correlates with the severity of fibrosis. More recently, it was demonstrated that in progressive liver disease, the stiffness of hepatic tissue actually increases prior to the onset of histological fibrosis. This is thought to represent the effects of early changes in the macromolecular composition of the extracellular matrix (ECM). It has also been shown that increased ECM stiffness actually promotes the development of hepatic fibrosis through a process known as mechanotransduction. Magnetic resonance elastography (MRE) is an MRI-based technique for quantitatively assessing the mechanical properties of tissue [1,2,3]. The main clinical application at the present time is for noninvasive assessment of hepatic fibrosis. FDA-cleared upgrades to equip conventional MRI scanners for MRE are available from ...

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Impact of Modified TICI 3 versus Modified TICI 2b Reperfusion Score to Predict Good Outcome following Endovascular Therapy

Abstract: Patients with modified TICI 3 reperfusion have better functional outcomes than those with modified TICI 2b. Given the improving reperfusion rates obtained with thrombectomy devices, future thrombectomy trials should consider modified TICI 2b and modified TICI 3 status separately.

Cited by 136 publications

References 28 publications

Onset to Reperfusion Time Was Not Important in Mechanical Thrombectomy for Elderly Patients: A Retrospective Multicenter Study in Tama Area, Tokyo

Onset to Reperfusion Time Was Not Important in Mechanical Thrombectomy for Elderly Patients: A Retrospective Multicenter Study in Tama Area, Tokyo

Is Reperfusion Useful in Ischaemic Stroke Patients Presenting with a Low National Institutes of Health Stroke Scale and a Proximal Large Vessel Occlusion of the Anterior Circulation?

Thursday 19 October 2017

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