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Ischemic stroke
Review
Successful mechanical thrombectomy in acute ischemic stroke: revascularization grade and functional independence
  1. Sherief Ghozy1,
  2. Salah Eddine Oussama Kacimi2,
  3. Ahmed Y Azzam3,
  4. Ramadan Abdelmoez Farahat4,
  5. Abdelaziz Abdelaal5,
  6. Kevin M Kallmes6,7,
  7. Gautam Adusumilli8,
  8. Jeremy J Heit9,
  9. Ramanathan Kadirvel1,
  10. David F Kallmes1
  1. 1 Department of Neuroradiology, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Faculty of Medicine, University of Tlemcen, Tlemcen, Algeria
  3. 3 Faculty of Medicine, October 6 University, Giza, Egypt
  4. 4 Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
  5. 5 Postgraduate Medical Education, Harvard Medical School, Boston, Massachusetts, USA
  6. 6 Nested Knowledge, St. Paul, Minnesota, USA
  7. 7 Superior Medical Experts, St. Paul, Minnesota, USA
  8. 8 Department of Surgery, Stanford University, Palo Alto, California, USA
  9. 9 Department of Neuroradiology and Neurosurgery, Stanford University, Palo Alto, California, USA
  1. Correspondence to Dr Sherief Ghozy, Department of Radiology, Mayo Clinic Minnesota, Rochester, Minnesota, USA; ghozy.sherief{at}mayo.edu

Abstract

Most studies define the technical success of endovascular thrombectomy (EVT) as a Thrombolysis in Cerebral Infarction (TICI) revascularization grade of 2b or higher. However, growing evidence suggests that TICI 3 is the best angiographic predictor of improved functional outcomes. To assess the association between successful TICI revascularization grades and functional independence at 90 days, we performed a systematic review and network meta-analysis of thrombectomy studies that reported TICI scores and functional outcomes, measured by the modified Rankin Scale, using the semi-automated AutoLit software platform. Forty studies with 8691 patients were included in the quantitative synthesis. Across TICI, modified TICI (mTICI), and expanded TICI (eTICI), the highest rate of good functional outcomes was observed in patients with TICI 3 recanalization, followed by those with TICI 2c and TICI 2b recanalization, respectively. Rates of good functional outcomes were similar among patients with either TICI 2c or TICI 3 grades. On further sensitivity analysis of the eTICI scale, the rates of good functional outcomes were equivalent between eTICI 2b50 and eTICI 2b67 (OR 0.81, 95% CI 0.52 to 1.25). We conclude that near complete or complete revascularization (TICI 2c/3) is associated with higher rates of functional outcomes after EVT.

  • stroke
  • thrombectomy

https://doi.org/10.1136/neurintsurg-2021-018436

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    Footnotes

    • Twitter @SalahEddineOus3, @JeremyHeitMDPHD

    • Contributors SG, RK, and DFK contributed to the conception, design of the work, and revising it critically for important intellectual content. SG performed the statistical analysis. All authors contributed to the acquisition, interpretation of data and drafting the work. All authors approved the final version of this manuscript to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • 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 KMK works for and holds equity in Nested Knowledge Inc, works for Conway Medical LLC, and holds equity in Superior Medical Experts Inc. JJH is a consultant for Medtronic and MicroVention and a member of the Medical and Scientific Advisory Board for iSchemaView.

    • 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.