RT Journal Article
SR Electronic
T1 eTICI reperfusion: defining success in endovascular stroke therapy
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 433
OP 438
DO 10.1136/neurintsurg-2018-014127
VO 11
IS 5
A1 David S Liebeskind
A1 Serge Bracard
A1 Francis Guillemin
A1 Reza Jahan
A1 Tudor G Jovin
A1 Charles BLM Majoie
A1 Peter J Mitchell
A1 Aad van der Lugt
A1 Bijoy K Menon
A1 Luis San Román
A1 Bruce CV Campbell
A1 Keith W Muir
A1 Michael D Hill
A1 Diederik WJ Dippel
A1 Jeffrey L Saver
A1 Andrew M Demchuk
A1 Antoni Dávalos
A1 Philip White
A1 Scott Brown
A1 Mayank Goyal
A1 ,
YR 2019
UL http://jnis.bmj.com/content/11/5/433.abstract
AB Background Revascularization after endovascular therapy for acute ischemic stroke is measured by the Thrombolysis In Cerebral Infarction (TICI) scale, yet variability exists in scale definitions. We examined the degree of reperfusion with the expanded TICI (eTICI) scale and association with outcomes in the HERMES collaboration of recent endovascular trials.Methods The HERMES Imaging Core, blind to all other data, evaluated angiography after endovascular therapy in HERMES. A battery of TICI scores (mTICI, TICI, TICI2C) was used to define reperfusion of the initial target occlusion defined by non-invasive imaging and conventional angiography.Results Angiography of 801 subjects was available, including 797 defined by non-invasive imaging (154 internal carotid artery (ICA), 583 M1, 60 M2) and 748 by conventional angiography (195 ICA, 459 M1, 94 M2). Among 729 subjects in whom the reperfusion grade could be established, using eTICI (3=100%, 2C=90–99%, 2b67=67–89%, 2b50=50–66%) of the conventional angiography target occlusion, there were 63 eTICI 3 (9%), 166 eTICI 2c (23%), 218 eTICI 2b67 (30%), 103 eTICI 2b50 (14%), 100 eTICI 2a (14%), 19 eTICI 1 (3%), and 60 eTICI 0 (8%). Modified Rankin Scale shift analyses from baseline to 90 days showed that increasing TICI grades were linked with better outcomes, with significant distinctions between TICI 0/1 versus 2a (p=0.028), 2a versus 2b50 (p=0.017), and 2b50 versus 2b67 (p=0.014).Conclusions The benefit of endovascular therapy in HERMES was strongly associated with increasing degrees of reperfusion defined by eTICI. The eTICI metric identified meaningful distinctions in clinical outcomes and may be used in future studies and routine practice.