eTICI reperfusion: defining success in endovascular stroke therapy

Shit, they are measuring the wrong thing. The correct measurement is 100% recovery, NOT this intermediate stage. No wonder no one ever solves anything in stroke. They aren't even trying for the right endpoint.  Reperfusion was a success, but the patient is still disabled. Not my definition of success or any stroke survivors.  And no measurement of reperfusion injury? Does anyone even know how to do research?

eTICI reperfusion: defining success in endovascular stroke therapy

Liebeskind DS^1,2, Bracard S³, Guillemin F⁴, Jahan R², Jovin TG⁵, Majoie CB⁶, Mitchell PJ⁷, van der Lugt A⁸, Menon BK⁹, San Román L¹⁰, Campbell BC¹¹, Muir KW¹², Hill MD⁹, Dippel DW¹³, Saver JL², Demchuk AM⁹, Dávalos A¹⁴, White P¹⁵, Brown S¹⁶, Goyal M^9,17; HERMES Collaborators.

Author information

Abstract

BACKGROUND:

Revascularization after endovascular therapy for acute ischemic stroke is measured by the Thrombolysis In Cerebral Infarction (TICI) scale, yet variability exists in scale definitions. We examined the degree of reperfusion with the expanded TICI (eTICI) scale and association with outcomes in the HERMES collaboration of recent endovascular trials.

METHODS:

The HERMES Imaging Core, blind to all other data, evaluated angiography after endovascular therapy in HERMES. A battery of TICI scores (mTICI, TICI, TICI2C) was used to define reperfusion of the initial target occlusion defined by non-invasive imaging and conventional angiography.

RESULTS:

Angiography of 801 subjects was available, including 797 defined by non-invasive imaging (154 internal carotid artery (ICA), 583 M1, 60 M2) and 748 by conventional angiography (195 ICA, 459 M1, 94 M2). Among 729 subjects in whom the reperfusion grade could be established, using eTICI (3=100%, 2C=90-99%, 2b67=67-89%, 2b50=50-66%) of the conventional angiography target occlusion, there were 63 eTICI 3 (9%), 166 eTICI 2c (23%), 218 eTICI 2b67 (30%), 103 eTICI 2b50 (14%), 100 eTICI 2a (14%), 19 eTICI 1 (3%), and 60 eTICI 0 (8%). Modified Rankin Scale shift analyses from baseline to 90 days showed that increasing TICI grades were linked with better outcomes, with significant distinctions between TICI 0/1 versus 2a (p=0.028), 2a versus 2b50 (p=0.017), and 2b50 versus 2b67 (p=0.014).

CONCLUSIONS:

The benefit of endovascular therapy in HERMES was strongly associated with increasing degrees of reperfusion defined by eTICI. The eTICI metric identified meaningful distinctions in clinical outcomes and may be used in future studies and routine practice.

© Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ.

KEYWORDS:

angiography; stroke

PMID:

30194109

DOI:

10.1136/neurintsurg-2018-014127