Impact of Modified TICI 3 versus Modified TICI 2b Reperfusion Score to Predict Good Outcome following Endovascular Therapy.
The TICI score is widely used to evaluate cerebral perfusion before and after the endovascular treatment of stroke. Recent studies showing the effectiveness and safety of mechanical thrombectomy combine modified TICI 2b and modified TICI 3 to assess the technical success of endovascular treatment. The purpose of this study was to determine how much clinical outcomes differ between patients achieving modified TICI 2b and modified TICI 3 reperfusion.



We analyzed 222 consecutive patients with acute large intracranial artery occlusion of the anterior circulation having achieved modified TICI 2b or modified TICI 3 reperfusion after thrombectomy. The primary end point was the rate of favorable outcome defined as the achievement of a modified Rankin Scale score of 0-2 at 3 months.



Patients with modified TICI 3 more often had favorable collateral circulation and atherosclerosis etiology, with a shorter time from onset to reperfusion than patients with modified TICI 2b (all P < .05). The number of total passes to achieve reperfusion was higher in the modified TICI 2b group (median, 2; interquartile range, 1-3, 1-9) versus (median, 1; interquartile range, 1-2, 1-8) in the modified TICI 3 group (P = .0002). Favorable outcome was reached more often for patients with modified TICI 3 than for those with modified TICI 2b (71.7% versus 50.5%, P = .001), with a similar difference when considering excellent outcome. In addition, patients with modified TICI 3 had a lower intracerebral hemorrhage rate (23.0% versus 45.0%, P < .001).



Patients with modified TICI 3 reperfusion have better functional outcomes than those with modified TICI 2b. Given the improving reperfusion rates obtained with thrombectomy devices, future thrombectomy trials should consider modified TICI 2b and modified TICI 3 status separately.
From the Departments of Interventional Neuroradiology (C.D., M.B., H.R., G.C., S.S., J.P.D., M.P., R.B.) c.dargazanli@gmail.com.
C
0000-0003-1891-9157
C
Dargazanli
Department of Diagnostic and Interventional Neuroradiology (A.C., O.C., G.R.).
A
0000-0001-6640-8541
A
Consoli
From the Departments of Interventional Neuroradiology (C.D., M.B., H.R., G.C., S.S., J.P.D., M.P., R.B.).
M
0000-0002-9741-1214
M
Barral
Department of Biostatistics (J.L.), University of Lille, Epidémiologie et Qualité des Soins, Lille, France.
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0000-0002-3384-0423
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Labreuche
From the Departments of Interventional Neuroradiology (C.D., M.B., H.R., G.C., S.S., J.P.D., M.P., R.B.).
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0000-0002-6943-9922
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Redjem
From the Departments of Interventional Neuroradiology (C.D., M.B., H.R., G.C., S.S., J.P.D., M.P., R.B.).
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0000-0001-5801-0816
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Ciccio
From the Departments of Interventional Neuroradiology (C.D., M.B., H.R., G.C., S.S., J.P.D., M.P., R.B.).
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0000-0002-6486-1710
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Smajda
From the Departments of Interventional Neuroradiology (C.D., M.B., H.R., G.C., S.S., J.P.D., M.P., R.B.).
J P
0000-0001-8395-6312
JP
Desilles
Anesthesiology and Reanimation (G.T.), Rothschild Foundation, Paris, France.
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0000-0002-5761-9803
G
Taylor
Laboratoire de Mathématiques Paul Painlevé (C.P.), Lille, France.
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0000-0001-6787-7374
C
Preda
Department of Diagnostic and Interventional Neuroradiology (A.C., O.C., G.R.).
O
0000-0002-9968-358X
O
Coskun
Department of Diagnostic and Interventional Neuroradiology (A.C., O.C., G.R.).
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0000-0001-5858-9522
G
Rodesch
From the Departments of Interventional Neuroradiology (C.D., M.B., H.R., G.C., S.S., J.P.D., M.P., R.B.).
M
0000-0002-1354-4328
M
Piotin
From the Departments of Interventional Neuroradiology (C.D., M.B., H.R., G.C., S.S., J.P.D., M.P., R.B.).
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0000-0002-0086-8614
R
Blanc
Division of Neurology, Stroke Center (B.L.), Foch Hospital, Université Versailles Saint Quentin en Yvelines, Suresnes, France.
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0000-0002-8993-2175
B
Lapergue
D000368:Aged; D000369:Aged, 80 and over; D002548:Cerebral Revascularization / Q000379:methods*; D003097:Collateral Circulation; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000601:surgery*; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome