title: Revascularization grading in endovascular acute ischemic stroke therapy.
abstract: BACKGROUND
  Recanalization and angiographic reperfusion are key elements to successful endovascular and interventional acute ischemic stroke (AIS) therapy. Intravenous recombinant tissue plasminogen activator (rt-PA), the only established revascularization therapy approved by the US Food & Drug Administration for AIS, may be less effective for large artery occlusion. Thus, there is enthusiasm for endovascular revascularization therapies, which likely provide higher recanalization rates, and trials are ongoing to determine clinical efficacy and compare various methods. It is anticipated that clinical efficacy will be well correlated with revascularization of viable tissue in a timely manner.
  
  
  METHODS
  Reporting, interpretation, and comparison of the various revascularization grading methods require agreement on measurement criteria, reproducibility, ease of use, and correlation with clinical outcome. These parameters were reviewed by performing a Medline literature search from 1965 to 2011. This review critically evaluates current revascularization grading systems.
  
  
  CONCLUSIONS
  The most commonly used revascularization grading methods in AIS interventional therapy trials are the thrombolysis in cerebral ischemia (TICI, pronounced "tissy") and thrombolysis in myocardial ischemia (TIMI) scores. Until further technical and imaging advances can incorporate real-time reliable perfusion studies in the angio-suite to delineate regional perfusion more accurately, the TICI grading system is the best defined and most widely used scheme. Other grading systems may be used for research and correlation purposes. A new scale that combines primary site occlusion, lesion location, and perfusion should be explored in the future.
authors.affiliation: Department of Neurology, Medical College of Wisconsin/Froedtert Hospital, Milwaukee, WI, USA. szaidat@mcw.edu
authors.forename: O O
authors.initials: OO
authors.lastname: Zaidat
authors.forename: M A
authors.initials: MA
authors.lastname: Lazzaro
authors.forename: D S
authors.initials: DS
authors.lastname: Liebeskind
authors.forename: N
authors.initials: N
authors.lastname: Janjua
authors.forename: L
authors.initials: L
authors.lastname: Wechsler
authors.forename: R G
authors.initials: RG
authors.lastname: Nogueira
authors.forename: R C
authors.initials: RC
authors.lastname: Edgell
authors.forename: J S
authors.initials: JS
authors.lastname: Kalia
authors.forename: A
authors.initials: A
authors.lastname: Badruddin
authors.forename: J
authors.initials: J
authors.lastname: English
authors.forename: D
authors.initials: D
authors.lastname: Yavagal
authors.forename: J F
authors.initials: JF
authors.lastname: Kirmani
authors.forename: A V
authors.initials: AV
authors.lastname: Alexandrov
authors.forename: P
authors.initials: P
authors.lastname: Khatri
mesh_terms: D000818:Animals; D002545:Brain Ischemia / Q000473:pathology* / Q000628:therapy; D002548:Cerebral Revascularization / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D012720:Severity of Illness Index; D020521:Stroke / Q000473:pathology* / Q000628:therapy; D015912:Thrombolytic Therapy / Q000379:methods