Time to redefine success? TICI 3 versus TICI 2b recanalization in middle cerebral artery occlusion treated with thrombectomy.

Kleine, Justus F; Wunderlich, Silke; Zimmer, Claus; Kaesmacher, Johannes

doi:10.1136/neurintsurg-2015-012218

2017

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Document type:: Journal Article
Author(s):: Kleine, Justus F; Wunderlich, Silke; Zimmer, Claus; Kaesmacher, Johannes
Title:: Time to redefine success? TICI 3 versus TICI 2b recanalization in middle cerebral artery occlusion treated with thrombectomy.
Abstract:: The Thrombolysis in Cerebral Infarction (TICI) scale is the most widely applied scoring system to grade technical results of recanalizing therapies in acute ischemic stroke (AIS). TICI 2b and TICI 3 are conventionally subsumed as 'successful recanalization'. Previous studies reported conflicting results for the clinical relevance of achieving complete (TICI 3) versus 'almost' complete reperfusion (TICI 2b).To examine if neurologic outcome differs significantly between TICI 2b and TICI 3 in patients with AIS with middle cerebral artery (MCA) occlusion treated 'successfully' with mechanical thrombectomy (MTE).Retrospective analysis of prospectively collected data from 352 consecutive patients with isolated MCA occlusion subjected to MTE between January 2007 and July 2015.262 of the 277 successfully treated patients had adequate follow-up and were included. Patients (n=119) in the TICI 3 group had a lower National Institutes of Health Stroke Scale score at discharge (NIHSS-DIS; median 5 vs 7, p=0.005), and showed higher rates of strong neurologic improvement (?NIHSS>=8 or NIHSS-DIS<=1, 68.4% vs 37.1%, p=0.002) and favorable NIHSS outcome (NIHSS-DIS<=5, 49.2% vs 31.9%, p=0.005). Hospital stays were shorter in the TICI 3 group (median 10 vs 12 days, p=0.014). After adjusting for relevant baseline and treatment parameters, TICI 3 was independently associated with strong neurologic improvement (OR=4.3, 95% CI 2.2 to 8.3, p<0.001) and favorable NIHSS outcome (OR=3.0, 95% CI 1.5 to 6.3, p=0.003).Neurologic outcome is substantially better in TICI 3 than TICI 2b patients, and hospital stays are shorter. Endovascular strategies that consequently strive to achieve TICI 3 may be warranted and cost-effective, and should be examined by future research. TICI 3 rates should be included as a safety measure in studies evaluating MTE devices and techniques.
Journal title abbreviation:: J Neurointerv Surg
Year:: 2017
Journal volume:: 9
Journal issue:: 2
Pages contribution:: 117-121
Language:: eng
Fulltext / DOI:: doi:10.1136/neurintsurg-2015-012218
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/26888952
Print-ISSN:: 1759-8478
TUM Institution:: Fachgebiet Neuroradiologie (Prof. Zimmer); Neurologische Klinik und Poliklinik
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