title: Recanalization and Angiographic Reperfusion Are Both Associated with a Favorable Clinical Outcome in the IMS III Trial.
abstract: BACKGROUND
  Prompt revascularization is the main goal of acute ischemic stroke treatment. We examined which revascularization scale - reperfusion (modified Treatment in Cerebral Infarctions, mTICI) or recanalization (Arterial Occlusive Lesion, AOL) - better predicted the clinical outcome in ischemic stroke participants treated with endovascular therapy (EVT). Additionally, we determined the optimal thresholds for the predictive accuracy of each scale.
  
  
  METHODS
  We included participants from the Interventional Management of Stroke (IMS) III trial with complete occlusion in the internal carotid artery terminus or proximal middle cerebral artery (M1 or M2) who completed EVT within 7 h of symptom onset. The abilities of the AOL and mTICI scales to predict a favorable outcome (defined as a modified Rankin Scale score of 0-2 at 3 months) were compared by receiver operating characteristic analyses. The maximal sensitivity and specificity for each revascularization scale were established.
  
  
  RESULTS
  Among 240 participants who met the study inclusion criteria, 79 (33%) achieved a favorable outcome. Higher scores of mTICI and AOL increased the likelihood of a favorable outcome (2.7% with mTICI 0 vs. 83.3% with mTICI 3, and 3.0% with AOL 0 vs. 43% with AOL 3). The accuracy of mTICI reperfusion and AOL recanalization for a favorable outcome prediction was similar, with optimal thresholds of mTICI 2b/3 and AOL 3, respectively.
  
  
  CONCLUSIONS
  Reperfusion (mTICI) and recanalization (AOL) predicted a favorable clinical outcome with comparable accuracy in ischemic stroke participants treated with EVT. Optimal revascularization goals to maximize clinical outcome (modified Rankin Scale score of 0-2) consisted of complete recanalization (AOL 3) and reperfusion of at least 50% of the arterial tree of the symptomatic artery (mTICI 2b/3) in the IMS III trial setting.
authors: Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
authors: Marie L
authors: ML
authors: Schmitz
authors: Medical University of South Carolina (MUSC), Charleston, USA.
authors: Sharon D
authors: SD
authors: Yeatts
authors: University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
authors: Thomas A
authors: TA
authors: Tomsick
authors: University of California Los Angeles (UCLA), Los Angeles, Calif., USA.
authors: David S
authors: DS
authors: Liebeskind
authors: University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
authors: Achala
authors: A
authors: Vagal
authors: University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
authors: Joseph P
authors: JP
authors: Broderick
authors: University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
authors: Pooja
authors: P
authors: Khatri
keywords: Acute stroke; Endovascular stroke therapy; Ischemic stroke; Revascularization; Stroke thrombectomy