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Extended Thrombolysis In Cerebral Infarction (eTICI) grade 2c: a potential angiographic target for endovascular treatment in acute basilar artery occlusion?
  1. Luming Chen1,
  2. Chenghao Zhao1,
  3. Jiaxing Song1,
  4. Wenjie Zi1,
  5. Hongfei Sang1,
  6. Junjie Yuan1,
  7. Jiacheng Huang1,
  8. Linyu Li1,
  9. Weidong Luo1,
  10. Xinmin Fu2,
  11. Peiyang Zhou3,
  12. Yue Wan4,
  13. Guoyong Zeng5,
  14. Dongjing Xie1,
  15. Fei Gao1,
  16. Fengli Li1,
  17. Zhongming Qiu1,6,
  18. Qingwu Yang1
  1. 1Department of Neurology, Xinqiao Hospital Department of Neurology, Chongqing, China
  2. 2Xuzhou Central Hospital, Xuzhou, China
  3. 3The First People’s Hospital of Xiangyang, Hubei Medical University, Department of Neurology, Xiangyang, China
  4. 4Hubei Zhongshan Hospital, Wuhan, China
  5. 5Neurology, Ganzhou People's Hospital, Ganzhou, China
  6. 6Neurology, 903th Hospital of PLA, Hangzhou, Zhejiang, China
  1. Correspondence to Dr Qingwu Yang, chongqing, China; Yangqwmlys{at}163.com

Abstract

Background Higher extended Thrombolysis In Cerebral Infarction (eTICI) grades are associated with better clinical outcomes after endovascular treatment (EVT) for proximal intracranial occlusion of the anterior circulation. However, the relationship between eTICI grade and outcomes after EVT in patients with acute basilar artery occlusion (BAO) remains unclear. We aimed to explore which eTICI category was the cut-off correlating with better clinical outcomes in patients with BAO undergoing EVT.

Methods We included patients treated via EVT from the BASILAR study. Multivariable logistic regression analyses were performed to assess the impact of eTICI grades on 90-day favorable functional outcomes, defined as a modified Rankin Scale (mRS) score of 0–3. Other outcomes were functional independence (mRS 0–2), all-cause mortality, and symptomatic intracranial hemorrhage.

Results Among 647 patients treated with EVT, 127 (19.6%), 128 (24.5%), 110 (21.1%), and 282 (54%) patients achieved eTICI grades of 0–2a, 2b, 2c, and 3, respectively. Compared with eTICI grades 0–2a, higher rates of favorable functional outcomes (adjusted OR (aOR) 2.96, 95% CI 1.33 to 6.57, and aOR 7.40, 95% CI 3.63 to 15.09, respectively) were observed for grades 2c and 3, not 2b (aOR 1.93, 95% CI 0.86 to 4.36). The risks of mortality and symptomatic intracranial hemorrhage were also lower for eTICI grades 2c and 3 than for grades 0–2a.

Conclusions An eTICI grade of 2c/3 may be a target for successful reperfusion after EVT in patients with acute BAO; however, further studies with larger sample sizes and clinical trials are needed.

  • angiography
  • artery
  • stroke
  • intervention

Data availability statement

Data are available in a public, open access repository.

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Data availability statement

Data are available in a public, open access repository.

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Footnotes

  • LC, CZ and JS contributed equally.

  • Contributors LC conceived the study idea, filtered and analyzed the data, was a major contributor in writing the manuscript, and was responsible for most revisions and submissions. CZ, JS: acquisition, analysis and interpretation of data, critical revision of the manuscript for important intellectual content. HS, WZ helped conceive the study idea and contributed to writing and revising the manuscript. DX, FG, FL, ZQ: acquisition of data. XF, PZ, YW, GZ contributed to data filtering and manuscript writing. JY, JH, LL, WL helped acquire the data. QY: acting as guarantor. supported the entire project, study concept and design, critical revision of the manuscript for important intellectual content, study supervision.

  • 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 Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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