title: Time to redefine success? TICI 3 versus TICI 2b recanalization in middle cerebral artery occlusion treated with thrombectomy.
abstract: BACKGROUND
  The Thrombolysis in Cerebral Infarction (TICI) scale is the most widely applied scoring system to grade technical results of recanalizing therapies in acute ischemic stroke (AIS). TICI 2b and TICI 3 are conventionally subsumed as 'successful recanalization'. Previous studies reported conflicting results for the clinical relevance of achieving complete (TICI 3) versus 'almost' complete reperfusion (TICI 2b).
  
  
  OBJECTIVE
  To examine if neurologic outcome differs significantly between TICI 2b and TICI 3 in patients with AIS with middle cerebral artery (MCA) occlusion treated 'successfully' with mechanical thrombectomy (MTE).
  
  
  METHODS
  Retrospective analysis of prospectively collected data from 352 consecutive patients with isolated MCA occlusion subjected to MTE between January 2007 and July 2015.
  
  
  RESULTS
  262 of the 277 successfully treated patients had adequate follow-up and were included. Patients (n=119) in the TICI 3 group had a lower National Institutes of Health Stroke Scale score at discharge (NIHSS-DIS; median 5 vs 7, p=0.005), and showed higher rates of strong neurologic improvement (ΔNIHSS≥8 or NIHSS-DIS≤1, 68.4% vs 37.1%, p=0.002) and favorable NIHSS outcome (NIHSS-DIS≤5, 49.2% vs 31.9%, p=0.005). Hospital stays were shorter in the TICI 3 group (median 10 vs 12 days, p=0.014). After adjusting for relevant baseline and treatment parameters, TICI 3 was independently associated with strong neurologic improvement (OR=4.3, 95% CI 2.2 to 8.3, p<0.001) and favorable NIHSS outcome (OR=3.0, 95% CI 1.5 to 6.3, p=0.003).
  
  
  CONCLUSIONS
  Neurologic outcome is substantially better in TICI 3 than TICI 2b patients, and hospital stays are shorter. Endovascular strategies that consequently strive to achieve TICI 3 may be warranted and cost-effective, and should be examined by future research. TICI 3 rates should be included as a safety measure in studies evaluating MTE devices and techniques.
authors.affiliation: Abteilung für diagnostische und interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Justus F
authors.identifier: http://orcid.org/0000-0002-2803-075X
authors.initials: JF
authors.lastname: Kleine
authors.affiliation: Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Silke
authors.initials: S
authors.lastname: Wunderlich
authors.affiliation: Abteilung für diagnostische und interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Zimmer
authors.affiliation: Abteilung für diagnostische und interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Kaesmacher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000601:surgery; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000601:surgery; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome
keywords: Stroke; Thrombectomy