Refining angiographic biomarkers of revascularization: improving outcome prediction after intra-arterial therapy. Stroke 2013 Sep;44(9):2509-12
Date
08/08/2013Pubmed ID
23920017Pubmed Central ID
PMC4142767DOI
10.1161/STROKEAHA.113.001990Scopus ID
2-s2.0-84884502622 (requires institutional sign-in at Scopus site) 210 CitationsAbstract
BACKGROUND AND PURPOSE: Angiographic revascularization grading after intra-arterial stroke therapy is limited by poor standardization, making it unclear which scale is optimal for predicting outcome. Using recently standardized criteria, we sought to compare the prognostic performance of 2 commonly used reperfusion scales.
METHODS: Inclusion criteria for this multicenter retrospective study were acute ischemic stroke attributable to middle cerebral artery M1 occlusion, intra-arterial therapy, and 90-day modified Rankin scale score. Post-intra-arterial therapy reperfusion was graded using the Thrombolysis in Myocardial Infarction (TIMI) and Modified Thrombolysis in Cerebral Infarction (mTICI) scales. The scales were compared for prediction of clinical outcome using receiver-operating characteristic analysis.
RESULTS: Of 308 patients, mean age was 65 years, and median National Institutes of Health Stroke Scale score was 17. The mean time from stroke onset to groin puncture was 305 minutes. There was no difference in the time to treatment between patients grouped by final TIMI (ie, 0 versus 1 versus 2 versus 3) or mTICI grades (ie, 0 versus 1 versus 2a versus 2b versus 3). Good outcome (modified Rankin scale, 0-2) was achieved in 32.5% of patients, and mortality rate was 25.3% at 90 days. There was a 6.3% rate of parenchymal hematoma type 2. In receiver-operating characteristic analysis, mTICI was superior to TIMI for predicting 90-day modified Rankin scale 0 to 2 (c-statistic: 0.74 versus 0.68; P<0.0001). The optimal threshold for identifying a good outcome was mTICI 2b to 3 (sensitivity 78.0%; specificity 66.1%).
CONCLUSIONS: mTICI is superior to TIMI for predicting clinical outcome after intra-arterial therapy. mTICI 2b to 3 is the optimal biomarker for procedural success.
Author List
Yoo AJ, Simonsen CZ, Prabhakaran S, Chaudhry ZA, Issa MA, Fugate JE, Linfante I, Liebeskind DS, Khatri P, Jovin TG, Kallmes DF, Dabus G, Zaidat OO, Cerebral Angiographic Revascularization Grading CollaboratorsMESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
Biomarkers
Cerebral Angiography
Cerebrovascular Circulation
Female
Fibrinolytic Agents
Humans
Infarction, Middle Cerebral Artery
Injections, Intra-Arterial
Male
Middle Aged
Predictive Value of Tests
Prognosis
Retrospective Studies
Thrombolytic Therapy
Trauma Severity Indices
Treatment Outcome
