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Ghozy S, Kacimi SEO, Azzam AY, Farahat RA, Abdelaal A, Kallmes KM, Adusumilli G, Heit JJ, Kadirvel R, Kallmes DF. Successful mechanical thrombectomy in acute ischemic stroke: revascularization grade and functional independence. J Neurointerv Surg 2022; 14:779-782. [PMID: 35022301 DOI: 10.1136/neurintsurg-2021-018436] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/31/2021] [Indexed: 12/18/2022]
Abstract
Most studies define the technical success of endovascular thrombectomy (EVT) as a Thrombolysis in Cerebral Infarction (TICI) revascularization grade of 2b or higher. However, growing evidence suggests that TICI 3 is the best angiographic predictor of improved functional outcomes. To assess the association between successful TICI revascularization grades and functional independence at 90 days, we performed a systematic review and network meta-analysis of thrombectomy studies that reported TICI scores and functional outcomes, measured by the modified Rankin Scale, using the semi-automated AutoLit software platform. Forty studies with 8691 patients were included in the quantitative synthesis. Across TICI, modified TICI (mTICI), and expanded TICI (eTICI), the highest rate of good functional outcomes was observed in patients with TICI 3 recanalization, followed by those with TICI 2c and TICI 2b recanalization, respectively. Rates of good functional outcomes were similar among patients with either TICI 2c or TICI 3 grades. On further sensitivity analysis of the eTICI scale, the rates of good functional outcomes were equivalent between eTICI 2b50 and eTICI 2b67 (OR 0.81, 95% CI 0.52 to 1.25). We conclude that near complete or complete revascularization (TICI 2c/3) is associated with higher rates of functional outcomes after EVT.
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Affiliation(s)
- Sherief Ghozy
- Department of Neuroradiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Ahmed Y Azzam
- Faculty of Medicine, October 6 University, Giza, Egypt
| | | | - Abdelaziz Abdelaal
- Postgraduate Medical Education, Harvard Medical School, Boston, Massachusetts, USA
| | - Kevin M Kallmes
- Nested Knowledge, St. Paul, Minnesota, USA.,Superior Medical Experts, St. Paul, Minnesota, USA
| | - Gautam Adusumilli
- Department of Surgery, Stanford University, Palo Alto, California, USA
| | - Jeremy J Heit
- Department of Neuroradiology and Neurosurgery, Stanford University, Palo Alto, California, USA
| | | | - David F Kallmes
- Department of Neuroradiology, Mayo Clinic, Rochester, Minnesota, USA
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