title: TICI and Age: What's the Score?
abstract: Previous studies have suggested that advanced age predicts worse outcome following mechanical thrombectomy. We assessed outcomes from 2 recent large prospective studies to determine the association among TICI, age, and outcome.
  
  
  
  Data from the Solitaire FR Thrombectomy for Acute Revascularization (STAR) trial, an international multicenter prospective single-arm thrombectomy study and the Solitaire arm of the Solitaire FR With the Intention For Thrombectomy (SWIFT) trial were pooled. TICI was determined by core laboratory review. Good outcome was defined as an mRS score of 0-2 at 90 days. We analyzed the association among clinical outcome, successful-versus-unsuccessful reperfusion (TICI 2b-3 versus TICI 0-2a), and age (dichotomized across the median).
  
  
  
  Two hundred sixty-nine of 291 patients treated with Solitaire in the STAR and SWIFT data bases for whom TICI and 90-day outcome data were available were included. The median age was 70 years (interquartile range, 60-76 years) with an age range of 25-88 years. The mean age of patients 70 years of age or younger was 59 years, and it was 77 years for patients older than 70 years. There was no significant difference between baseline NIHSS scores or procedure time metrics. Hemorrhage and device-related complications were more common in the younger age group but did not reach statistical significance. In absolute terms, the rate of good outcome was higher in the younger population (64% versus 44%, P < .001). However, the magnitude of benefit from successful reperfusion was higher in the 70 years of age and older group (OR, 4.82; 95% CI, 1.32-17.63 versus OR 7.32; 95% CI, 1.73-30.99).
  
  
  
  Successful reperfusion is the strongest predictor of good outcome following mechanical thrombectomy, and the magnitude of benefit is highest in the patient population older than 70 years of age.
authors.affiliation: From the Division of Neuroradiology (L.A.S., J.M.C., V.M.P.), Joint Department of Medical Imaging, Department of Medical Imaging.
authors.forename: L A
authors.identifier: 0000-0002-1140-8664
authors.initials: LA
authors.lastname: Slater
authors.affiliation: From the Division of Neuroradiology (L.A.S., J.M.C., V.M.P.), Joint Department of Medical Imaging, Department of Medical Imaging.
authors.forename: J M
authors.identifier: 0000-0002-8284-982X
authors.initials: JM
authors.lastname: Coutinho
authors.affiliation: Service of Neuroradiology (J.G.), Inselspital, University of Bern, Bern, Switzerland.
authors.forename: J
authors.identifier: 0000-0003-1953-9033
authors.initials: J
authors.lastname: Gralla
authors.affiliation: Marcus Stroke and Neuroscience Center (R.G.N.), Department of Neurology, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: R G
authors.identifier: 0000-0003-4532-153X
authors.initials: RG
authors.lastname: Nogueira
authors.affiliation: Department of Neuroradiology (A.B.), Hôpital Gui-de-Chauliac, Montpellier, France.
authors.forename: A
authors.identifier: 0000-0002-9187-1375
authors.initials: A
authors.lastname: Bonafé
authors.affiliation: Department of Neurosciences (A.D.), Hospital Universitario Germans Trias i Pujol, Barcelona, Spain.
authors.forename: A
authors.identifier: 0000-0003-2949-5679
authors.initials: A
authors.lastname: Dávalos
authors.affiliation: Division of Interventional Neuroradiology (R.J.).
authors.forename: R
authors.identifier: 0000-0001-7389-6352
authors.initials: R
authors.lastname: Jahan
authors.affiliation: Toshiba Stroke and Vascular Research Center (E.L.), State University of New York at Buffalo, Buffalo, New York.
authors.forename: E
authors.identifier: 0000-0002-6208-3724
authors.initials: E
authors.lastname: Levy
authors.affiliation: Department of Radiology (B.J.B.), Erlanger Hospital at the University of Tennessee, Chattanooga, Tennessee.
authors.forename: B J
authors.identifier: 0000-0002-3403-428X
authors.initials: BJ
authors.lastname: Baxter
authors.affiliation: Department of Neurology and Comprehensive Stroke Center (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: J L
authors.identifier: 0000-0001-9141-2251
authors.initials: JL
authors.lastname: Saver
authors.affiliation: From the Division of Neuroradiology (L.A.S., J.M.C., V.M.P.), Joint Department of Medical Imaging, Department of Medical Imaging Division of Neurosurgery (V.M.P.), Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada vitormpbr@hotmail.com.
authors.forename: V M
authors.identifier: 0000-0002-6804-3985
authors.initials: VM
authors.lastname: Pereira
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002548:Cerebral Revascularization / Q000379:methods*; D002986:Clinical Trials as Topic; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D015424:Reperfusion / Q000379:methods; D020521:Stroke / Q000601:surgery*; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult