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The semiotics of distal thrombectomy: towards a TICI score for the target vessel
  1. Alejandro M Spiotta1,
  2. David Fiorella2,
  3. Adam S Arthur3,
  4. Donald Frei4,
  5. Aquilla S Turk1,
  6. Joshua A Hirsch5
  1. 1 Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
  2. 2 Cerebrovascular Center, Stony Brook University, Stony Brook, New York, USA
  3. 3 Department of Neurosurgery, Semmes-Murphey Clinic, Memphis, Tennessee, USA
  4. 4 Radiology Imaging Associates, Swedish Medical Center, Englewood, Colorado, USA
  5. 5 Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Alejandro M Spiotta, Department of Neurosurgery, Medical University of South Carolina, Charleston SC 29425, USA; spiotta{at}

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The Thrombolysis in Cerebral Infarction (TICI) grading system was first described by Higashida in 20031 and later modified.2 More recently a 2C grade (near complete, >90%) has been adopted widely (table 1).3 However, this grading system is based on the assumption that the emergent large vessel occlusion (ELVO) involves the M1 segment (or carotid terminus) and loses relevance when this is not the case. Consider a superior division M2 occlusion, for example. Assuming codominant M2 divisions, from the onset of the procedure the TICI grade would be a 2B: an endpoint indicating successful recanalization in the historical literature. If partial M2 recanalization was achieved it may still be graded as a 2B at the conclusion, rendering it impossible to decipher if progress had been made. An alternative approach would be to grade the M2 occlusion a ‘target vessel TICI’ 0. In this manner, at the procedure conclusion, whether it remained a 0 or if it were recanalized …

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