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

doi: 10.15274/INR-2014-10004

Mohammed A Almekhlafi1,2, Sachin Mishra1, Jamsheed A Desai1, Vivek Nambiar1, Ondrej Volny1,6, Ankur Goel1, Muneer Eesa1,3, Andrew M Demchuk1,3,4, Bijoy K Menon1,3,4,5, Mayank Goyal1,3,4

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

Key words: stroke, prognosis, thrombectomy


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.

Mayank Goyal, MD, FRCPC
Department of Radiology, HBI
University of Calgary
Foothills Medical Center, 1403 29th
St NW, Calgary, AB, Canada T2N 2T9
Tel.: 403 944 3379
Fax: 403 270 7907

Volume 20 - No. 1 - January/February 2014

Create date: 15/01/2014 | Last update: 15/01/2014