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

• Published in: World neurosurgery 2018-11, Vol.119, p.e928-e933
• Main Authors: Naragum, Varun, Jindal, Gaurav, Miller, Timothy, Kole, Matthew, Shivashankar, Ravishankar, Merino, Jose G., Cole, John, Chen, Rong, Kohler, Nathan, Gandhi, Dheeraj
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Cerebral infarction; Cerebral Revascularization - methods; Female; Fibrinolytic Agents - therapeutic use; Humans; Infarction, Middle Cerebral Artery - complications; Infarction, Middle Cerebral Artery - surgery; Large vessel occlusion; Length of Stay - statistics & numerical data; Male; Middle Aged; Prospective Studies; Recovery of Function; Reperfusion; Retrospective Studies; Stroke; Stroke - etiology; Stroke - physiopathology; Stroke - surgery; Thrombectomy; Thrombectomy - methods; Thrombolysis In Cerebral Infarction 2c; TICI 2c; Tissue Plasminogen Activator - therapeutic use; Treatment Outcome
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.08.006

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. 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. 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). 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. •Patients with TICI 2c reperfusion achieve better clinical outcomes compared with patients with TICI 2b.•Patients with TICI 2c reperfusion achieve similar clinical outcomes compared with patients with TICI 3.•TICI 2c and TICI 3 reperfusion should be pursued if feasible and safe.