title: Not all "successful" angiographic reperfusion patients are an equal validation of a modified TICI scoring system.
abstract: Rapid reperfusion of the entire territory distal to vascular occlusions is the aim of stroke interventions. Recent studies defined successful reperfusion as establishing some perfusion with distal branch filling of <50% of territory visualized (Thrombolysis In Cerebral Infarction "TICI" 2a) or more. We investigate the importance of the quality of final reperfusion and whether a revision of the successful reperfusion definition is warranted. We retrospectively evaluated a prospective database of anterior circulation strokes treated using stentrievers to assess the quality of final reperfusion using two scores: the traditional TICI score and a modified TICI score. The modified TICI score includes an additional category (TICI 2c): near complete perfusion except for slow flow or distal emboli in a few distal cortical vessels. We compared different cut-off definitions of reperfusion (TICI 2a - 3 vs. TICI-2b-3 vs. TICI 2c-3) using the area under the curve to identify their correlation with a favorable 90-day outcome (mRS≤2). In our cohort of 110 patients, 90% achieved TICI 2a-3 reperfusion with 80% achieving TICI 2b-3 and 55.5% achieving TICI 2c-3. The proportion of patients with a favorable 90-day outcome was higher in the TICI 2c (62.5%) compared to TICI 2b (44.4%) or TICI 2a (45.5%) but similar to the TICI 3 group (75.9%). A TICI 2c-3 reperfusion had a better predictive value than TICI 2b-3 for 90-day mRS 0-1. Defining successful reperfusion as TICI 2c/3 has merits. In this cohort, there was evidence toward faster recovery and better outcomes in patients with the TICI 2c vs. the traditional TICI 2b grade.
authors.affiliation: Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary; Calgary, Canada - Department of Internal Medicine, King Abdulaziz University; Jeddah, Saudi Arabia - mgoyal@ucalgary.ca.
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Almekhlafi
authors.affiliation: Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary; Calgary, Canada.
authors.forename: Sachin
authors.initials: S
authors.lastname: Mishra
authors.affiliation: Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary; Calgary, Canada.
authors.forename: Jamsheed A
authors.initials: JA
authors.lastname: Desai
authors.affiliation: Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary; Calgary, Canada.
authors.forename: Vivek
authors.initials: V
authors.lastname: Nambiar
authors.affiliation: Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary; Calgary, Canada - First Neurological Clinic and International Clinical Research Centre; Brno, Czech Republic.
authors.forename: Ondrej
authors.initials: O
authors.lastname: Volny
authors.affiliation: Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary; Calgary, Canada.
authors.forename: Ankur
authors.initials: A
authors.lastname: Goel
authors.affiliation: Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary; Calgary, Canada - Department of Radiology, University of Calgary; Calgary, Canada.
authors.forename: Muneer
authors.initials: M
authors.lastname: Eesa
authors.affiliation: Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary; Calgary, Canada - Department of Radiology, University of Calgary; Calgary, Canada - Hotchkiss Brain Institute; Calgary, Canada.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Demchuk
authors.affiliation: Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary; Calgary, Canada - Department of Radiology, University of Calgary; Calgary, Canada - Hotchkiss Brain Institute; Calgary, Canada - Department of Community Health Sciences, University of Calgary; Calgary, Canada.
authors.forename: Bijoy K
authors.initials: BK
authors.lastname: Menon
authors.affiliation: Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary; Calgary, Canada - Department of Radiology, University of Calgary; Calgary, Canada - Hotchkiss Brain Institute; Calgary, Canada.
authors.forename: Mayank
authors.initials: M
authors.lastname: Goyal
mesh_terms: D000368:Aged; D000416:Alberta / Q000453:epidemiology; D002533:Cerebral Angiography / Q000706:statistics & numerical data*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D061185:Mechanical Thrombolysis / Q000706:statistics & numerical data*; D015588:Observer Variation; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data*; D015995:Prevalence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome
keywords: prognosis; stroke; thrombectomy