Revascularization grading in endovascular acute ischemic stroke therapy. Neurology 2012 Sep 25;79(13 Suppl 1):S110-6
Date
10/04/2012Pubmed ID
23008384Pubmed Central ID
PMC4109231DOI
10.1212/WNL.0b013e3182695916Scopus ID
2-s2.0-84867502402 (requires institutional sign-in at Scopus site) 63 CitationsAbstract
BACKGROUND: Recanalization and angiographic reperfusion are key elements to successful endovascular and interventional acute ischemic stroke (AIS) therapy. Intravenous recombinant tissue plasminogen activator (rt-PA), the only established revascularization therapy approved by the US Food & Drug Administration for AIS, may be less effective for large artery occlusion. Thus, there is enthusiasm for endovascular revascularization therapies, which likely provide higher recanalization rates, and trials are ongoing to determine clinical efficacy and compare various methods. It is anticipated that clinical efficacy will be well correlated with revascularization of viable tissue in a timely manner.
METHOD: Reporting, interpretation, and comparison of the various revascularization grading methods require agreement on measurement criteria, reproducibility, ease of use, and correlation with clinical outcome. These parameters were reviewed by performing a Medline literature search from 1965 to 2011. This review critically evaluates current revascularization grading systems.
RESULTS AND CONCLUSION: The most commonly used revascularization grading methods in AIS interventional therapy trials are the thrombolysis in cerebral ischemia (TICI, pronounced "tissy") and thrombolysis in myocardial ischemia (TIMI) scores. Until further technical and imaging advances can incorporate real-time reliable perfusion studies in the angio-suite to delineate regional perfusion more accurately, the TICI grading system is the best defined and most widely used scheme. Other grading systems may be used for research and correlation purposes. A new scale that combines primary site occlusion, lesion location, and perfusion should be explored in the future.
Author List
Zaidat OO, Lazzaro MA, Liebeskind DS, Janjua N, Wechsler L, Nogueira RG, Edgell RC, Kalia JS, Badruddin A, English J, Yavagal D, Kirmani JF, Alexandrov AV, Khatri PAuthor
Marc A. Lazzaro MD Associate Professor in the Neurology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AnimalsBrain Ischemia
Cerebral Revascularization
Endovascular Procedures
Humans
Severity of Illness Index
Stroke
Thrombolytic Therapy
