Functional Independence After Stroke Thrombectomy Using Thrombolysis In Cerebral Infarction Grade 2c: A New Aim of Successful Revascularization

World Neurosurg. 2018 Nov;119:e928-e933. doi: 10.1016/j.wneu.2018.08.006. Epub 2018 Aug 10.

Abstract

Background: Within the Thrombolysis In Cerebral Infarction (TICI) classification, TICI 2b has been historically considered successful recanalization. However, TICI 2b may result in worse functional outcomes compared with TICI 3 or a proposed TICI 2c revascularization grade. The aim of this study was to evaluate differences in functional independence at 90 days between TICI 2b, 2c, and 3 grades.

Methods: A retrospective review of 185 consecutive patients with anterior cerebral circulation occlusions was performed; 33 patients who were treated >8 hours after onset were excluded. Patient angiograms were graded by 2 experienced neurointerventional physicians. Baseline demographics and functional independence at 90 days were compared.

Results: Of 152 patients included in the study, 113 patients achieved TICI grade 2b (n = 37), 2c (n = 34), or 3 (n = 42). A significant difference in functional independence at 90 days was observed between TICI 2b and 2c/3 (P = 0.0008), between 2b and 2c (P = 0.0005), and between 2b and 3 (P = 0.01). There was no significant difference in functional independence between 2c and 3 (P = 0.24).

Conclusions: TICI 2c revascularization is associated with significantly improved outcomes compared with TICI 2b revascularization and similar outcomes compared with TICI 3 revascularization. Using a TICI grading system that includes an additional TICI 2c grade or expands the current definition of TICI 3 allows for refined prediction of functional independence. Achieving TICI 2c/3 reperfusion should be considered during stroke thrombectomy.

Keywords: Cerebral infarction; Large vessel occlusion; Reperfusion; Stroke; TICI 2c; Thrombectomy; Thrombolysis In Cerebral Infarction 2c.

Publication types

  • Comparative Study

MeSH terms

  • Activities of Daily Living
  • Cerebral Revascularization / methods*
  • Female
  • Fibrinolytic Agents / therapeutic use
  • Humans
  • Infarction, Middle Cerebral Artery / complications
  • Infarction, Middle Cerebral Artery / surgery
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Prospective Studies
  • Recovery of Function
  • Retrospective Studies
  • Stroke / etiology
  • Stroke / physiopathology
  • Stroke / surgery*
  • Thrombectomy / methods*
  • Tissue Plasminogen Activator / therapeutic use
  • Treatment Outcome

Substances

  • Fibrinolytic Agents
  • Tissue Plasminogen Activator