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Interv Neuroradiol. 2014 Jan-Feb;20(1):21-7. Epub 2014 Feb 10.

Not all "successful" angiographic reperfusion patients are an equal validation of a modified TICI scoring system.

Author information

1
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary; Calgary, Canada - Department of Internal Medicine, King Abdulaziz University; Jeddah, Saudi Arabia - mgoyal@ucalgary.ca.
2
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary; Calgary, Canada.
3
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary; Calgary, Canada - First Neurological Clinic and International Clinical Research Centre; Brno, Czech Republic.
4
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary; Calgary, Canada - Department of Radiology, University of Calgary; Calgary, Canada.
5
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary; Calgary, Canada - Department of Radiology, University of Calgary; Calgary, Canada - Hotchkiss Brain Institute; Calgary, Canada.
6
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary; Calgary, Canada - Department of Radiology, University of Calgary; Calgary, Canada - Hotchkiss Brain Institute; Calgary, Canada - Department of Community Health Sciences, University of Calgary; Calgary, Canada.

Abstract

Rapid reperfusion of the entire territory distal to vascular occlusions is the aim of stroke interventions. Recent studies defined successful reperfusion as establishing some perfusion with distal branch filling of <50% of territory visualized (Thrombolysis In Cerebral Infarction "TICI" 2a) or more. We investigate the importance of the quality of final reperfusion and whether a revision of the successful reperfusion definition is warranted. We retrospectively evaluated a prospective database of anterior circulation strokes treated using stentrievers to assess the quality of final reperfusion using two scores: the traditional TICI score and a modified TICI score. The modified TICI score includes an additional category (TICI 2c): near complete perfusion except for slow flow or distal emboli in a few distal cortical vessels. We compared different cut-off definitions of reperfusion (TICI 2a - 3 vs. TICI-2b-3 vs. TICI 2c-3) using the area under the curve to identify their correlation with a favorable 90-day outcome (mRS≤2). In our cohort of 110 patients, 90% achieved TICI 2a-3 reperfusion with 80% achieving TICI 2b-3 and 55.5% achieving TICI 2c-3. The proportion of patients with a favorable 90-day outcome was higher in the TICI 2c (62.5%) compared to TICI 2b (44.4%) or TICI 2a (45.5%) but similar to the TICI 3 group (75.9%). A TICI 2c-3 reperfusion had a better predictive value than TICI 2b-3 for 90-day mRS 0-1. Defining successful reperfusion as TICI 2c/3 has merits. In this cohort, there was evidence toward faster recovery and better outcomes in patients with the TICI 2c vs. the traditional TICI 2b grade.

KEYWORDS:

prognosis; stroke; thrombectomy

PMID:
24556296
PMCID:
PMC3971136
DOI:
10.15274/INR-2014-10004
[Indexed for MEDLINE]
Free PMC Article

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