RT Journal Article SR Electronic T1 Comparison of Thrombolysis In Cerebral Infarction (TICI) 2b and TICI 3 reperfusion in endovascular therapy for large ischemic anterior circulation strokes JF Journal of NeuroInterventional Surgery JO J NeuroIntervent Surg FD BMJ Publishing Group Ltd. SP 1076 OP 1082 DO 10.1136/jnis-2023-020724 VO 16 IS 11 A1 Winkelmeier, Laurens A1 Faizy, Tobias D A1 Brekenfeld, Caspar A1 Heitkamp, Christian A1 Broocks, Gabriel A1 Bechstein, Matthias A1 Steffen, Paul A1 Schell, Maximilian A1 Gellissen, Susanne A1 Kniep, Helge A1 Thomalla, Goetz A1 Fiehler, Jens A1 Flottmann, Fabian A1 YR 2024 UL http://jnis.bmj.com/content/16/11/1076.abstract AB Background Landmark thrombectomy trials have provided evidence that selected patients with large ischemic stroke benefit from successful endovascular therapy, commonly defined as incomplete (modified Thrombolysis In Cerebral Infarction (mTICI) 2b) or complete reperfusion (mTICI 3). We aimed to investigate whether mTICI 3 improves functional outcomes compared with mTICI 2b in large ischemic strokes.Methods This retrospective multicenter cohort study was conducted to compare mTICI 2b versus mTICI 3 in large ischemic strokes in the anterior circulation. Patients enrolled in the German Stroke Registry between 2015–2021 were analyzed. Large ischemic stroke was defined as an Alberta Stroke Program Early CT Score (ASPECTS) of 3–5. Patients were matched by final mTICI grade using propensity score matching. Primary outcome was the 90-day modified Rankin Scale (mRS) score.Results After matching, 226 patients were included. Baseline and imaging characteristics were balanced between mTICI 2b and mTICI 3 patients. There was no shift on the mRS favoring mTICI 3 compared with mTICI 2b in large ischemic strokes (adjusted common odds ratio (acOR) 1.12, 95% confidence interval (95% CI) 0.64 to 1.94, P=0.70). The rate of symptomatic intracranial hemorrhage was higher in mTICI 2b than in mTICI 3 patients (12.6% vs 4.5%, P=0.03). Mortality at 90 days did not differ between mTICI 3 and mTICI 2b (33.6% vs 37.2%; adjusted OR 0.69, 95% CI 0.33 to 1.45, P=0.33).Conclusions In endovascular therapy for large ischemic strokes, mTICI 3 was not associated with better 90-day functional outcomes compared with mTICI 2b. This study suggests that mTICI 2b might be warranted as the final angiographic result, questioning the benefit/risk ratio of additional maneuvers to seek for mTICI 3 in large ischemic strokes.Trial registration number NCT03356392.The data that support the findings of this study are available upon reasonable request after approval of the ethics committee and all participating centers. Data may be obtained from a third party (GSR) and are not publicly available. The data that support the findings of this study are available from the GSR.