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

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

Daniel Behme  1 , Ioannis Tsogkas  1 , Ruben Colla  1 , Roland G Gera  2 , Katharina Schregel  1 , Amélie C Hesse  1 , Ilko L Maier  3 , Jan Liman  3 , David S Liebeskind  4 , Marios-Nikos Psychogios  1
Affiliations

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

Daniel Behme et al. PLoS One. .

Abstract

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.

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Conflict of interest statement

The authors of this manuscript declare relationships with the following companies: All: none regarding the content of the manuscript. DB is consultant for Phenox. Minor speaking honorary and travel grants were received by MNP and DB from Siemens, Phenox, Penumbra, Acandis and Stryker. All other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1
Ap and lateral views of LAO and eTICI2b50 (mTICI2b) reperfusion results (a+b) ap and lateral views showing a M1 occlusion of the left side (c+d) after recanalization the inferior MCA trunk remains occluded, additionally the frontal division is not fully reperfused. Severe filling defects can be seen in the parietal and frontal part of the MCA territory.
Fig 2
Fig 2
Ap and lateral views of LAO and eTICI2b67(mTICI2b) reperfusion results (a+b) ap and lateral views of a M1 occlusion of the right side (c+d) ap and lateral view after reperfusion showing a remaining MCA M2 division being still occluded which is led to incomplete reperfusion (central and parietal MCA territory not fully reperfused).
Fig 3
Fig 3
Ap and lateral views of LAO and eTICI2c (mTICI2b) reperfusion results (a+b) ap and lateral views showing a distal ICA occlusion (c+d) after thrombectomy only very small distal branches in parietal location do not fill.
Fig 4
Fig 4. ROC for eTICI and mTICI.
See this image and copyright information in PMC

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