Introduction The relationship between the two angiographic parameters, recanalization and reperfusion, as they relate to clinical outcome of acute stroke patients undergoing endovascular intervention is not well defined. We sought to determine the relationship of recanalization of the primary arterial occlusive lesion (AOL) and global reperfusion of the distal vascular bed in patients treated with endovascular stroke rescue at our institution.
Hypothesis We assessed the hypothesis that recanalization and reperfusion scores would comparably predict outcome.
Methods 96 angiograms were reanalyzed using recanalization and reperfusion scores by neurointerventionalists blinded to clinical outcome. The AOL score was defined as follows: 0=no recanalization of the primary occlusion; I=incomplete or partial recanalization of the primary occlusion with no distal flow; II=incomplete or partial recanalization of the primary occlusion with distal flow; or III=complete recanalization of the primary occlusion with distal flow. The Thrombolysis in Cerebral Infarction (TICI) Score was defined as follows: 0=no perfusion; 1= penetration, but no distal branch filling; 2a= perfusion with incomplete (<50%) distal branch filling; 2b=perfusion with incomplete (>50%) distal branch filling; and 3=full perfusion with filling of all distal branches. We compared these methods of assessment to one another and with good clinical outcome (modified Rankin Score 0 to 2).
Results AOL and TICI scores showed moderate to substantial agreement (κ=0.660, 95% CI (0.518 to 0.801). Good clinical outcome was seen in 60% of patients with AOL II/III scores (p=0.462) and in 71% with TICI 2/3 scores (p=0.854). The two methods did not significantly differ in predicting outcome (p=0.52).
Conclusion In conclusion, TICI reperfusion scores and AOL recanalization scores comparably predicted clinical outcome in our patient population. However, further investigation should be performed, possibly with the aid of other imaging modalities, to further differentiate between these parameters and their relationship to clinical outcome.
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Disclosures R Sugg: None. W Holloway: None. C Martin: None. N Akhtar: None. M Rymer: 2; C; Concentric.