Article Text

Original research
Time to redefine success? TICI 3 versus TICI 2b recanalization in middle cerebral artery occlusion treated with thrombectomy
  1. Justus F Kleine1,
  2. Silke Wunderlich2,
  3. Claus Zimmer1,
  4. Johannes Kaesmacher1
  1. 1Abteilung für diagnostische und interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
  2. 2Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
  1. Correspondence to Dr Justus F Kleine, Abteilung für diagnostische und interventionelle Neuroradiologie, Technische Universität München, Ismaninger Str 22, Munich 81675, Germany; Justus.kleine{at}


Background 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).

Objective 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).

Methods Retrospective analysis of prospectively collected data from 352 consecutive patients with isolated MCA occlusion subjected to MTE between January 2007 and July 2015.

Results 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 (ΔNIHSS≥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).

Conclusions 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.

  • Stroke
  • Thrombectomy

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  • Contributors JFK conceived the research, participated in the literature search, collected, analysed, and interpreted the data, and wrote and revised the paper. He is the guarantor. JK conjointly conceived the research, performed the literature search, collected, analyzed, and interpreted the data, participated in the writing of the draft, and revised the paper. SW collected and analyzed data and revised the paper. CZ interpreted data and revised the paper.

  • Competing interests None declared.

  • Ethics approval Institutional ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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