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Lies, damned lies, and TICI
  1. Maxim Mokin1,
  2. Joshua A Hirsch2,
  3. David Fiorella3,
  4. Ashutosh P Jadhav4
  1. 1 Neurosurgery, University of South Florida, Tampa, Florida, USA
  2. 2 NeuroEndovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3 Department of Neurosurgery, Stony Brook University, Stony Brook, New York, USA
  4. 4 Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr Maxim Mokin, Department of Neurosurgery, University of South Florida, 2 Tampa General Circle, Tampa, FL 33606, USA; mokin{at}

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“Failure is success in progress,” is one of Albert Einstein’s quotes, emphasizing the importance of recognizing one’s own limitations. The devices we use in our daily neurointerventional practice are constantly undergoing changes and improvements, as well as the techniques and approaches we apply to treat a wide range of cerebrovascular pathologies. Yet, we continue to judge procedural success or failure based on the visual feedback—the approach that has remained fundamentally the same since the introduction of the digital subtraction angiography technique.

The Thrombolysis in Cerebral Infarction (TICI) scoring system is the uniform 'currency' we all use every day; it tells us when the thrombectomy procedure is completed or whether additional device passes are required, it is used by the regulatory agencies to evaluate device safety, and it allows us to compare trial results and determine if the 'next best thing' truly achieves superior and faster reperfusion rates, as claimed by the authors.1 It is not surprising therefore that the TICI scale has quickly found its way in the social media arena, with endless posts announcing first pass TICI 3 results greatly surpassing the clinical trial data or with claims of new devices’ 'superiority'. Dmytriw et al compared post-intervention Twitter reported thrombectomy outcomes with the Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke (HERMES) individual patient meta-analysis and showed a striking (over 20%) difference in the …

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  • Contributors All authors contributed equally.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.