Comparative Safety and Efficacy of Modified TICI 2b and TICI 3 Reperfusion in Acute Ischemic Strokes Treated with Mechanical Thrombectomy

Nitin Goyal, Georgios Tsivgoulis, Donald Frei, Aquilla Turk, Blaise Baxter, Michael T. Froehler, J. Mocco, Muhammad Fawad Ishfaq, Konark Malhotra, Jason J. Chang, Daniel Hoit, Lucas Elijovich, David Loy, Raymond D. Turner, Justin Mascitelli, Kiersten Espaillat, Andrei V. Alexandrov, Adam S. Arthur

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

BACKGROUND: Mechanical thrombectomy (MT) is the current standard of care for acute ischemic stroke (AIS) patients with emergent large-vessel occlusions (ELVO). Successful reperfusion of ELVOis traditionally defined by modified Thrombolysis in Cerebral Infarction (mTICI) grades of 2b or 3. OBJECTIVE: To evaluate the comparative safety and efficacy ofmTICI 2b andmTICI 3 reperfusion in AIS patients treated with MT. METHODS: Consecutive ELVO patients who underwent MT at 6 high-volume centers were included in this analysis. Standard safety (3-mo mortality, symptomatic intracranial hemorrhage [sICH]) and efficacy (absolute and relative reduction in NIHSS-scores during hospitalization, functional-improvement [shift analysis in mRS-scores], and functional-independence [mRS-scores of 0-2] at 3-mo) were compared between patients who had mTICI 2b and mTICI 3 reperfusion post MT. RESULTS: A total of 416 ELVO patients achieved successful reperfusion with mTICI 2b (n = 216) and mTICI 3 (n = 200) following MT. The mTICI 3 group had significantly (P < .05) greater absolute (11 vs 9 points) and relative (77% vs 63%) reduction in NIHSS-scores during hospitalization, lower sICH (6% vs 12%), and higher 3-mo functional-independence (55% vs 44%) rates. Successful reperfusion with mTICI 3 was independently (P < .05) associated with greater absolute and relative reduction in NIHSS-scores during hospitalization as well as higher odds of 3-mo functional improvement (commonodds ratios: 1.67;95%confidence interval: 1.10-2.56) and functional independence (odds ratio: 2.08; 95% confidence interval: 1.22-3.53) in multivariable regression models adjusting for confounders. CONCLUSION: Successful reperfusion with mTICI 3 was associated with greater neurological improvement during hospitalization and better 3-mo functional outcomes in comparison to mTICI 2b reperfusion.

Original languageEnglish (US)
Pages (from-to)680-686
Number of pages7
JournalClinical Neurosurgery
Volume84
Issue number3
DOIs
StatePublished - Mar 1 2019
Externally publishedYes

Keywords

  • Emergent large vessel occlusion
  • Mechanical thrombectomy
  • Modified TICI2b reperfusion
  • Modified TICI3 reperfusion
  • Outcome
  • Stroke

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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