Not All “Successful” Angiographic Reperfusion Patients Are an Equal Validation of a Modified TICI Scoring System

Almekhlafi, Mohammed; Mishra, Sachin; Desai, Jamsheed A.; Nambiar, Vivek; Volný, Ondřej; Goel, Ankur; Eesa, Muneer; Demchuk, Andrew M.; Menon, Bijoy K; Goyal, Mayank

doi:10.15274/inr-2014-10004

Cited by 128 publications

(108 citation statements)

References 25 publications

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“…Previously, a modified TICI (mTICI) score of 2B (reperfusion of more than half of the previously occluded target artery ischemic territory) or 3 was classified as successful. However, recent studies have reported an extension of mTICI (i.e., eTICI), adding a 2C score which indicates a near complete perfusion except for slow flow in a few distal cortical vessels or presence of distal cortical emboli [25, 26]. The effect of successful reperfusion on prognosis, either defined by eTICI ≥2B or ≥2C, was also assessed.…”

Section: Methodsmentioning

confidence: 99%

Importance of Reperfusion Status after Intra-Arterial Thrombectomy for Prediction of Outcome in Anterior Circulation Large Vessel Stroke

et al. 2018

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Background: Reperfusion status after intra-arterial thrombectomy (IAT) is a critical predictor of functional outcome after acute ischemic stroke. However, most prognostic models have not included a detailed assessment of reperfusion status after IAT. Objective: The aim of this work was to assess the association between successful reperfusion and clinical outcome. Methods: Clinical, radiological, and procedural variables of patients treated with IAT were extracted from our prospective stroke registry. The association with functional outcome using the modified Rankin Scale (mRS) after 3 months was assessed using multivariable logistic regression. An extension of the modified TICI score, eTICI, was used to classify reperfusion status. The prognostic value of reperfusion status after IAT in addition to age, stroke severity, imaging characteristics, treatment with intravenous thrombolysis, and time from symptom onset to the end of IAT was assessed with logistic regression and summarized with receiver operating characteristic curves. Results: In total, 119 patients were included (mean age 66 years). In multivariable analysis, age >80 years (OR 6.8, 95% CI 1.2–39.8), NIHSS at presentation >15 (OR 7.3, 95% CI 2.3–23.5), and incomplete reperfusion status (eTICI score <2C; OR 10.3, 95% CI 3.5–30.6) were the strongest predictors of a poor outcome (mRS 3–6). Adding reperfusion status to the model improved the prognostic accuracy (AUC 0.88, 95% CI 0.91–0.94). Our results indicate a large difference between using an eTICI cutoff of ≥2C versus ≥2B: a cutoff ≥2C improved the predictive value for a good clinical outcome (2C: positive predictive value, PPV, 0.78; 2B: PPV 0.32). Conclusion: Our results promote using reperfusion status for assessing prognosis in ischemic stroke patients treated with IAT. A model using eTICI ≥2C had greater PPV than eTICI ≥2B and could improve prognostic accuracy.

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Section: Methodsmentioning

confidence: 99%

Importance of Reperfusion Status after Intra-Arterial Thrombectomy for Prediction of Outcome in Anterior Circulation Large Vessel Stroke

et al. 2018

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“…19 Furthermore, Almekhlafi et al reported that a combined criterion subsuming TICI 2c/3 as "successful" revascularization might be a more accurate predictor of a favorable clinical outcome than the widely applied TICI 2b/3 criterion. 20 Further prospective studies using the TICI 2c category will be required to determine which grade best predicts patients' outcomes.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Poor Outcome after Successful Mechanical Thrombectomy in Patients with Acute Anterior Circulation Stroke

Tajima

Hayasaka

Ebihara

et al. 2017

J Clin Interv Radiol ISVIR

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Successful revascularization is one of the main predictors of a favorable clinical outcome after mechanical thrombectomy. However, even if mechanical thrombectomy is successful, some patients have a poor clinical outcome. This study aimed to investigate the clinical, imaging, and procedural factors that are predictive of poor clinical outcomes despite successful revascularization after mechanical thrombectomy in patients with acute anterior circulation stroke. The authors evaluated 69 consecutive patients (mean age, 74.6 years, 29 women) who presented with acute ischemic stroke due to internal cerebral artery or middle cerebral artery occlusions and who were successfully treated with mechanical thrombectomy between July 2014 and November 2016. A good outcome was defined as a modified Rankin Scale score of 0 to 2 at 3 months after treatment. The associations between the clinical, imaging, and procedural factors and poor outcome were evaluated using logistic regression analyses. Using multivariate analyses, the authors found that the preoperative National Institute of Health Stroke Scale (NIHSS) score (odds ratio [OR], 1.152; 95% confidence interval [CI], 1.004–1.325; p = 0.028), the diffusion-weighted imaging Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) (OR, 0.604; 95% CI, 0.412–0.882; p = 0.003), and a Thrombolysis in Cerebral Infarction (TICI) 2b classification (OR, 4.521; 95% CI, 1.140–17.885; p = 0.026) were independent predictors of poor outcome. Complete revascularization to reduce the infarct volume should be performed, especially in patients with a high DWI-ASPECTS, to increase the likelihood of a good outcome.

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“…30 Patients with mTICI 2C have better clinical outcome compared with mTICI 2B. 31 The problem of what represents good recanalization remains. What is the interventionalist's endpoint?…”

Section: Quality Of Recanalization/reperfusionmentioning

confidence: 99%

Endovascular Therapy in Acute Ischemic Stroke

Goyal

Menon

et al. 2016

Stroke

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Not All “Successful” Angiographic Reperfusion Patients Are an Equal Validation of a Modified TICI Scoring System

Cited by 128 publications

References 25 publications

Importance of Reperfusion Status after Intra-Arterial Thrombectomy for Prediction of Outcome in Anterior Circulation Large Vessel Stroke

Importance of Reperfusion Status after Intra-Arterial Thrombectomy for Prediction of Outcome in Anterior Circulation Large Vessel Stroke

Predictors of Poor Outcome after Successful Mechanical Thrombectomy in Patients with Acute Anterior Circulation Stroke

Endovascular Therapy in Acute Ischemic Stroke

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