Validation of the extended thrombolysis in cerebral infarction score in a real world cohort

PLoS One. 2019 Jan 10;14(1):e0210334. doi: 10.1371/journal.pone.0210334. eCollection 2019.


Background: A thrombolysis in cerebral infarction (TICI) score of 2b is defined as a good recanalization result although the reperfusion may only cover 50% of the affected territory. An additional mTICI2c category was introduced to further differentiate between mTICI scores. Despite the new mTICI2c category, mTICI2b still covers a range of 50-90% reperfusion which might be too imprecise to predict neurological improvement after therapy.

Aim: To compare the 7-point "expanded TICI" (eTICI) scale with the traditional mTICI in regard to predict functional independence at 90 days.

Methods: Retrospective review of 225 patients with large artery occlusion. Angiograms were graded by 2 readers according the 7-point eTICI score (0% = eTICI0; reduced clot = eTICI1; 1-49% = eTICI2a, 50-66% = eTICI2b50; 67-89% = eTICI2b67, 90-99% = eTICI2c and complete reperfusion = eTICI3) and the conventional mTICI score. The ability of e- and mTICI to predict favorable outcome at 90days was compared.

Results: Given the ROC analysis eTICI was the better predictor of favorable outcome (p-value 0.047). Additionally, eTICI scores 2b50, 2b67 and 2c (former mTICI2b) were significantly superior at predicting the probability of a favorable outcome at 90 days after endovascular therapy with a p-value of 0.033 (probabilities of 17% for mTICI2b50, 24% for mTICI2b67 and 54% for mTICI2c vs. 36% for mTICI2b).

Conclusions: The 7-point eTICI allows for a more accurate outcome prediction compared to the mTICI score because it refines the broad range of former mTICI2b results.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cerebral Infarction / diagnostic imaging
  • Cerebral Infarction / therapy*
  • Female
  • Humans
  • Male
  • Mechanical Thrombolysis*
  • ROC Curve
  • Reperfusion
  • Retrospective Studies
  • Treatment Outcome

Grant support

The authors received no specific funding for this work.