Correlation of AOL recanalization, TIMI reperfusion and TICI reperfusion with infarct growth and clinical outcome

Michael P Marks; Maarten G Lansberg; Michael Mlynash; Stephanie Kemp; Ryan McTaggart; Greg Zaharchuk; Roland Bammer; Gregory W Albers; DEFUSE 2 Investigators

doi:10.1136/neurintsurg-2013-010973

Correlation of AOL recanalization, TIMI reperfusion and TICI reperfusion with infarct growth and clinical outcome

J Neurointerv Surg. 2014 Dec;6(10):724-8. doi: 10.1136/neurintsurg-2013-010973. Epub 2013 Dec 18.

Authors

Michael P Marks¹, Maarten G Lansberg², Michael Mlynash², Stephanie Kemp², Ryan McTaggart¹, Greg Zaharchuk¹, Roland Bammer¹, Gregory W Albers³; DEFUSE 2 Investigators

Affiliations

¹ Departments of Radiology, Stanford University Medical Center, Stanford, California, USA Stanford Stroke Center, Stanford University Medical Center, Stanford, California, USA.
² Stanford Stroke Center, Stanford University Medical Center, Stanford, California, USA Departments of Neurology, Stanford University Medical Center, Stanford, California, USA.
³ Stanford Stroke Center, Stanford University Medical Center, Stanford, California, USA Stanford Stroke Center, Stanford University Medical Center, Stanford, California, USA.

Abstract

Objective: To understand how three commonly used measures of endovascular therapy correlate with clinical outcome and infarct growth.

Methods: Prospectively enrolled patients underwent baseline MRI and started endovascular therapy within 12 h of stroke onset. The final angiogram was given a primary arterial occlusive lesion (AOL) recanalization score (0-3), a Thrombolysis in Myocardial Infarction (TIMI) score (0-3) and a Thrombolysis in Cerebral Infarction (TICI) score (0-3). The scores were dichotomized into poor revascularization (AOL 0-2, TIMI 0-1 and TICI 0-2a) versus good revascularization (AOL 3, TIMI 2-3, TICI 2b-3). Patients were classified according to whether or not they had target mismatch (TMM). Good outcome was defined as a 90-day modified Rankin Scale score of 0-2.

Results: Endovascular treatment was attempted in 100. A good outcome was achieved in 57% of patients with a TICI score of 2b-3 and in 24% of patients with a TICI score of 0-2a (p=0.001). Patients with TIMI scores of 2-3 and an AOL score of 3 had lower rates of good outcome (44% and 47%, respectively), which were not significantly better than those with TIMI scores of 0-1 or AOL scores of 0-2. In patients with TMM, these rates of good outcome improved with all the scoring systems and were significantly better for TIMI and TICI scores. Patients with a TICI score of 2a had rates of good functional outcome and lesion growth which were not different from those with TICI scores of 0-1 but were significantly worse than those with TICI scores of 2b-3.

Conclusions: TIMI 2-3 and TICI 2b-3 reperfusion scores demonstrated improved outcome in patients with tissue mismatch with a small infarct core and a larger hypoperfused region but AOL scores did not. Patients with a TICI score of 2a had a poorer outcome and more lesion growth than those with TICI scores of 2b-3.

Keywords: Angiography; Intervention; MRI; Stroke.

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Publication types

Research Support, N.I.H., Extramural

MeSH terms

Aged
Cerebral Infarction / surgery*
Cerebral Revascularization / methods
Cerebral Revascularization / standards
Endovascular Procedures* / methods
Endovascular Procedures* / standards
Female
Humans
Magnetic Resonance Imaging, Interventional
Male
Prospective Studies
Severity of Illness Index
Treatment Outcome

Abstract

Publication types

MeSH terms

Grants and funding