Early TICI 2b or Late TICI 3—Is Perfect the Enemy of Good?
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| Title: | Early TICI 2b or Late TICI 3—Is Perfect the Enemy of Good? |
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| Authors: | Gsr investigators, M. E. Maros, Anna Alegiani, N. van Horn, Goetz Thomalla, Uta Hanning, Caspar Brekenfeld, Fabian Flottmann, Rosalie McDonough, Milani Deb-Chatterji, Jens Fiehler |
| Source: | Clin Neuroradiol |
| Publisher Information: | Springer Science and Business Media LLC, 2021. |
| Publication Year: | 2021 |
| Subject Terms: | 2. Zero hunger, Endovascular Procedures, Cerebral Infarction, Brain Ischemia, 3. Good health, Stroke, 03 medical and health sciences, Treatment Outcome, 0302 clinical medicine, Stroke/therapy [MeSH], Endovascular Procedures/methods [MeSH], Thrombectomy/methods [MeSH], Humans [MeSH], Treatment Outcome [MeSH], Cerebral Infarction [MeSH], Retrospective Studies [MeSH], Prognostic factors, Original Article, Retrievals, Ischemic Stroke [MeSH], Thrombectomy, Endovascular therapy, Reperfusion/methods [MeSH], Brain Ischemia/therapy [MeSH], Ischemic stroke, Reperfusion, Humans, 10. No inequality, Ischemic Stroke, Retrospective Studies |
| Description: | Background and PurposeA Thrombolysis in Cerebral Infarction (TICI) score of 3 has been established as therapeutic goal in endovascular therapy (EVT) for acute ischemic stroke; however, in the case of early TICI2b reperfusion, the question remains whether to stop the procedure or to continue in the pursuit of perfection (i.e., TICI 2c/3).MethodsA total of 6635 patients were screened from the German Stroke Registry. Patients who underwent EVT for occlusion of the middle cerebral artery (M1 segment), with final TICI score of 2b/3 were included. Multivariable logistic regression was performed with functional independence (modified Rankin Scale, mRS at day 90 of 0–2) as the dependent variable.ResultsOf 1497 patients, 586 (39.1%) met inclusion criteria with a final TICI score of 2b and 911 (60.9%) with a TICI score of 3. Patients who achieved first-pass TICI3 showed highest odds of functional independence (Odds ratio [OR] 1.71, 95% confidence interval [95% CI] 1.18–2.47). Patients who achieved TICI2b with the second pass (OR 0.53, 95% CI 0.31–0.89) or with three or more passes (OR 0.44, 95% CI 0.27–0.70) had significantly worse clinical outcomes compared to first-pass TICI2b. TICI3 at the second pass was by trend better than first-pass TICI2b (OR 1.55, 95% CI 0.98–2.45), but TICI3 after 3 or more passes (OR 0.93, 95% CI 0.57–1.50) was not significantly different from first-pass TICI2b.ConclusionFirst-pass TICI2b was superior to TICI2b after ≥ 2 retrievals and comparable to TICI3 at ≥ 3 retrievals. The potential benefit in outcome after achieving TICI3 following further retrieval attempts after first-pass TICI2b need to be weighed against the risks. |
| Document Type: | Article Other literature type |
| Language: | English |
| ISSN: | 1869-1447 1869-1439 |
| DOI: | 10.1007/s00062-021-01048-8 |
| Access URL: | https://link.springer.com/content/pdf/10.1007/s00062-021-01048-8.pdf https://pubmed.ncbi.nlm.nih.gov/34191040 https://www.ncbi.nlm.nih.gov/pubmed/34191040 https://link.springer.com/content/pdf/10.1007/s00062-021-01048-8.pdf https://link.springer.com/article/10.1007/s00062-021-01048-8 https://europepmc.org/article/MED/34191040 https://repository.publisso.de/resource/frl:6452180 |
| Rights: | CC BY |
| Accession Number: | edsair.doi.dedup.....b307e88c9ffe15b7c86bea57e1286d67 |
| Database: | OpenAIRE |
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Nájsť tento článok vo Web of Science | Abstract: | Background and PurposeA Thrombolysis in Cerebral Infarction (TICI) score of 3 has been established as therapeutic goal in endovascular therapy (EVT) for acute ischemic stroke; however, in the case of early TICI2b reperfusion, the question remains whether to stop the procedure or to continue in the pursuit of perfection (i.e., TICI 2c/3).MethodsA total of 6635 patients were screened from the German Stroke Registry. Patients who underwent EVT for occlusion of the middle cerebral artery (M1 segment), with final TICI score of 2b/3 were included. Multivariable logistic regression was performed with functional independence (modified Rankin Scale, mRS at day 90 of 0–2) as the dependent variable.ResultsOf 1497 patients, 586 (39.1%) met inclusion criteria with a final TICI score of 2b and 911 (60.9%) with a TICI score of 3. Patients who achieved first-pass TICI3 showed highest odds of functional independence (Odds ratio [OR] 1.71, 95% confidence interval [95% CI] 1.18–2.47). Patients who achieved TICI2b with the second pass (OR 0.53, 95% CI 0.31–0.89) or with three or more passes (OR 0.44, 95% CI 0.27–0.70) had significantly worse clinical outcomes compared to first-pass TICI2b. TICI3 at the second pass was by trend better than first-pass TICI2b (OR 1.55, 95% CI 0.98–2.45), but TICI3 after 3 or more passes (OR 0.93, 95% CI 0.57–1.50) was not significantly different from first-pass TICI2b.ConclusionFirst-pass TICI2b was superior to TICI2b after ≥ 2 retrievals and comparable to TICI3 at ≥ 3 retrievals. The potential benefit in outcome after achieving TICI3 following further retrieval attempts after first-pass TICI2b need to be weighed against the risks. |
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| ISSN: | 18691447 18691439 |
| DOI: | 10.1007/s00062-021-01048-8 |