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Original research
Correlation of AOL recanalization, TIMI reperfusion and TICI reperfusion with infarct growth and clinical outcome
  1. Michael P Marks1,2,
  2. Maarten G Lansberg2,3,
  3. Michael Mlynash2,3,
  4. Stephanie Kemp2,3,
  5. Ryan McTaggart1,2,
  6. Greg Zaharchuk1,2,
  7. Roland Bammer1,2,
  8. Gregory W Albers2,2
  9. for the DEFUSE 2 Investigators
  1. 1Departments of Radiology, Stanford University Medical Center, Stanford, California, USA
  2. 2Stanford Stroke Center, Stanford University Medical Center, Stanford, California, USA
  3. 3Departments of Neurology, Stanford University Medical Center, Stanford, California, USA
  1. Correspondence to Dr Michael Marks, Departments of Radiology and Neurosurgery, Stanford University Medical Center, 300 Pasteur Drive, Room S-047, Stanford, CA 94305-5105, USA; mmarks{at}stanford.edu

Abstract

Objective To understand how three commonly used measures of endovascular therapy correlate with clinical outcome and infarct growth.

Methods Prospectively enrolled patients underwent baseline MRI and started endovascular therapy within 12 h of stroke onset. The final angiogram was given a primary arterial occlusive lesion (AOL) recanalization score (0–3), a Thrombolysis in Myocardial Infarction (TIMI) score (0–3) and a Thrombolysis in Cerebral Infarction (TICI) score (0–3). The scores were dichotomized into poor revascularization (AOL 0–2, TIMI 0–1 and TICI 0–2a) versus good revascularization (AOL 3, TIMI 2–3, TICI 2b–3). Patients were classified according to whether or not they had target mismatch (TMM). Good outcome was defined as a 90-day modified Rankin Scale score of 0–2.

Results Endovascular treatment was attempted in 100. A good outcome was achieved in 57% of patients with a TICI score of 2b–3 and in 24% of patients with a TICI score of 0–2a (p=0.001). Patients with TIMI scores of 2–3 and an AOL score of 3 had lower rates of good outcome (44% and 47%, respectively), which were not significantly better than those with TIMI scores of 0–1 or AOL scores of 0–2. In patients with TMM, these rates of good outcome improved with all the scoring systems and were significantly better for TIMI and TICI scores. Patients with a TICI score of 2a had rates of good functional outcome and lesion growth which were not different from those with TICI scores of 0–1 but were significantly worse than those with TICI scores of 2b–3.

Conclusions TIMI 2–3 and TICI 2b–3 reperfusion scores demonstrated improved outcome in patients with tissue mismatch with a small infarct core and a larger hypoperfused region but AOL scores did not. Patients with a TICI score of 2a had a poorer outcome and more lesion growth than those with TICI scores of 2b–3.

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