title: Refining angiographic biomarkers of revascularization: improving outcome prediction after intra-arterial therapy.
abstract: OBJECTIVE
  Angiographic revascularization grading after intra-arterial stroke therapy is limited by poor standardization, making it unclear which scale is optimal for predicting outcome. Using recently standardized criteria, we sought to compare the prognostic performance of 2 commonly used reperfusion scales.
  
  
  METHODS
  Inclusion criteria for this multicenter retrospective study were acute ischemic stroke attributable to middle cerebral artery M1 occlusion, intra-arterial therapy, and 90-day modified Rankin scale score. Post-intra-arterial therapy reperfusion was graded using the Thrombolysis in Myocardial Infarction (TIMI) and Modified Thrombolysis in Cerebral Infarction (mTICI) scales. The scales were compared for prediction of clinical outcome using receiver-operating characteristic analysis.
  
  
  RESULTS
  Of 308 patients, mean age was 65 years, and median National Institutes of Health Stroke Scale score was 17. The mean time from stroke onset to groin puncture was 305 minutes. There was no difference in the time to treatment between patients grouped by final TIMI (ie, 0 versus 1 versus 2 versus 3) or mTICI grades (ie, 0 versus 1 versus 2a versus 2b versus 3). Good outcome (modified Rankin scale, 0-2) was achieved in 32.5% of patients, and mortality rate was 25.3% at 90 days. There was a 6.3% rate of parenchymal hematoma type 2. In receiver-operating characteristic analysis, mTICI was superior to TIMI for predicting 90-day modified Rankin scale 0 to 2 (c-statistic: 0.74 versus 0.68; P<0.0001). The optimal threshold for identifying a good outcome was mTICI 2b to 3 (sensitivity 78.0%; specificity 66.1%).
  
  
  CONCLUSIONS
  mTICI is superior to TIMI for predicting clinical outcome after intra-arterial therapy. mTICI 2b to 3 is the optimal biomarker for procedural success.
authors.affiliation: Division of Interventional Neuroradiology, Massachusetts General Hospital, Boston, MA, USA. ajyoo@partners.org
authors.forename: Albert J
authors.initials: AJ
authors.lastname: Yoo
authors.forename: Claus Z
authors.initials: CZ
authors.lastname: Simonsen
authors.forename: Shyam
authors.initials: S
authors.lastname: Prabhakaran
authors.forename: Zeshan A
authors.initials: ZA
authors.lastname: Chaudhry
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Issa
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Fugate
authors.forename: Italo
authors.initials: I
authors.lastname: Linfante
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
authors.forename: Pooja
authors.initials: P
authors.lastname: Khatri
authors.forename: Tudor G
authors.initials: TG
authors.lastname: Jovin
authors.forename: David F
authors.initials: DF
authors.lastname: Kallmes
authors.forename: Guilherme
authors.initials: G
authors.lastname: Dabus
authors.forename: Osama O
authors.initials: OO
authors.lastname: Zaidat
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D002533:Cerebral Angiography / Q000592:standards*; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D007269:Injections, Intra-Arterial / Q000592:standards; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000592:standards*; D015599:Trauma Severity Indices; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D005343:Fibrinolytic Agents
keywords: TIMI; acute ischemic stroke; endovascular; intra-arterial therapy; modified TICI; revascularization
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