Background and Purpose

A 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).

Methods

A 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.

Results

Of 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.

Conclusion

First-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.

中文翻译：

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TICI 2b 早期或 TICI 3 晚期——完美是善的敌人吗？

背景和目的

脑梗死溶栓（TICI）评分为 3 分已被确定为急性缺血性卒中血管内治疗（EVT）的治疗目标；然而，在早期 TICI2b 再灌注的情况下，问题仍然是是停止手术还是继续追求完美（即 TICI2c/3）。

方法

德国卒中登记处共筛选了 6635 名患者。纳入因大脑中动脉（M1 段）闭塞而接受 EVT，最终 TICI 评分为 2b/3 的患者。以功能独立性（改良的 Rankin 量表，0-2 第 90 天的 mRS）作为因变量进行多变量逻辑回归。

结果

在 1497 名患者中，586 名 (39.1%) 符合纳入标准，最终 TICI 评分为 2b，911 名 (60.9%) 符合纳入标准，TICI 评分为 3。首次通过 TICI3 的患者表现出最高的功能独立几率（优势比 [OR ] 1.71, 95% 置信区间 [95% CI] 1.18–2.47)。与第一次通过 TICI2b 相比，第二次通过（OR 0.53，95% CI 0.31-0.89）或三次或以上（OR 0.44，95% CI 0.27-0.70）达到 TICI2b 的患者临床结果明显更差。第二次通过的 TICI3 趋势优于第一次通过 TICI2b（OR 1.55，95% CI 0.98-2.45），但 3 次或更多次通过后的 TICI3（OR 0.93，95% CI 0.57-1.50）与第一次没有显着差异-通过TICI2b。

结论

首次通过 TICI2b 在 ≥ 2 次检索后优于 TICI2b，在 ≥ 3 次检索时与 TICI3 相当。需要权衡在首次通过 TICI2b 后进一步检索尝试后实现 TICI3 后结果的潜在收益与风险。