Johannes Kaesmacher1, Christian Maegerlein2, Felix Zibold3, Silke Wunderlich4, Claus Zimmer2, Benjamin Friedrich2. 1. Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, München, Germany. j.kaesmacher@tum.de. 2. Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, München, Germany. 3. Department of Diagnostic and Interventional Neuroradiology, Inselspital Bern, Bern, Switzerland. 4. Department of Neurology, Klinikum rechts der Isar, Technical University Munich, München, Germany.
Abstract
BACKGROUND: Recent studies suggested that modified Thrombolysis in Cerebral Infarction grade (mTICI) 3 reperfusions are associated with superior outcome to mTICI2b reperfusions, questioning if neurointerventionalists should generally strive to achieve mTICI3. METHODS: Retrospective analysis of successfully reperfused MCA occlusions (n=246) with available angiography runs between every manoeuvre was performed. Final reperfusion success and those between all single manoeuvres were evaluated applying the modified version of the TICI score (including TICI2c). Final TICI2c/3 reperfusions were dichotomized as 'direct' (reperfusion before final manoeuvre ≤mTICI2a) or 'secondary improved' (mTICI2b was achieved). RESULTS: Patients with mTICI2c reperfusion had similar outcome to patients with mTICI3 rather than mTICI2b reperfusions. Compared with mTICI2c/3-patients, mTICI2b-patients had lower rates of neurological improvement (33.3% vs. 61.2%, p<0.001) and good functional outcome (28.7% vs. 46.5%, p=0.008). In 28 patients, mTICI2b reperfusion was improved to mTICI2c/3 without complications. Outcome of patients with 'direct' or 'secondary improved' mTICI2c/3 did not differ (p>0.5). CONCLUSION: Improving mTICI2b reperfusions to mTICI2c/3 reperfusions is sometimes technically feasible and safe, and associated with clinical benefit comparable to 'direct' mTICI2c/3 reperfusions. If confirmed, a more aggressive treatment approach in cases of already achieved mTICI2b may be justified, although proper patient selection is needed. KEY POINTS: • Patients with mTICI2c or 3 reperfusions have a comparable clinical course. • mTICI2c/3 are associated with a larger therapeutic benefit than are mTICI2b reperfusions. • Improving reperfusion from mTICI2b to mTICI2c/3 is sometimes feasible and reasonably safe. • Outcome of patients with 'secondary improved' and 'direct' mTICI2c/3 is not different.
BACKGROUND: Recent studies suggested that modified Thrombolysis in Cerebral Infarction grade (mTICI) 3 reperfusions are associated with superior outcome to mTICI2b reperfusions, questioning if neurointerventionalists should generally strive to achieve mTICI3. METHODS: Retrospective analysis of successfully reperfused MCA occlusions (n=246) with available angiography runs between every manoeuvre was performed. Final reperfusion success and those between all single manoeuvres were evaluated applying the modified version of the TICI score (including TICI2c). Final TICI2c/3 reperfusions were dichotomized as 'direct' (reperfusion before final manoeuvre ≤mTICI2a) or 'secondary improved' (mTICI2b was achieved). RESULTS:Patients with mTICI2c reperfusion had similar outcome to patients with mTICI3 rather than mTICI2b reperfusions. Compared with mTICI2c/3-patients, mTICI2b-patients had lower rates of neurological improvement (33.3% vs. 61.2%, p<0.001) and good functional outcome (28.7% vs. 46.5%, p=0.008). In 28 patients, mTICI2b reperfusion was improved to mTICI2c/3 without complications. Outcome of patients with 'direct' or 'secondary improved' mTICI2c/3 did not differ (p>0.5). CONCLUSION: Improving mTICI2b reperfusions to mTICI2c/3 reperfusions is sometimes technically feasible and safe, and associated with clinical benefit comparable to 'direct' mTICI2c/3 reperfusions. If confirmed, a more aggressive treatment approach in cases of already achieved mTICI2b may be justified, although proper patient selection is needed. KEY POINTS: • Patients with mTICI2c or 3 reperfusions have a comparable clinical course. • mTICI2c/3 are associated with a larger therapeutic benefit than are mTICI2b reperfusions. • Improving reperfusion from mTICI2b to mTICI2c/3 is sometimes feasible and reasonably safe. • Outcome of patients with 'secondary improved' and 'direct' mTICI2c/3 is not different.
Authors: Mohammed A Almekhlafi; Sachin Mishra; Jamsheed A Desai; Vivek Nambiar; Ondrej Volny; Ankur Goel; Muneer Eesa; Andrew M Demchuk; Bijoy K Menon; Mayank Goyal Journal: Interv Neuroradiol Date: 2014-02-10 Impact factor: 1.610
Authors: C Dargazanli; A Consoli; M Barral; J Labreuche; H Redjem; G Ciccio; S Smajda; J P Desilles; G Taylor; C Preda; O Coskun; G Rodesch; M Piotin; R Blanc; B Lapergue Journal: AJNR Am J Neuroradiol Date: 2016-11-03 Impact factor: 3.825
Authors: Albert J Yoo; Claus Z Simonsen; Shyam Prabhakaran; Zeshan A Chaudhry; Mohammad A Issa; Jennifer E Fugate; Italo Linfante; David S Liebeskind; Pooja Khatri; Tudor G Jovin; David F Kallmes; Guilherme Dabus; Osama O Zaidat Journal: Stroke Date: 2013-08-06 Impact factor: 7.914
Authors: Jeffrey L Saver; Mayank Goyal; Alain Bonafe; Hans-Christoph Diener; Elad I Levy; Vitor M Pereira; Gregory W Albers; Christophe Cognard; David J Cohen; Werner Hacke; Olav Jansen; Tudor G Jovin; Heinrich P Mattle; Raul G Nogueira; Adnan H Siddiqui; Dileep R Yavagal; Blaise W Baxter; Thomas G Devlin; Demetrius K Lopes; Vivek K Reddy; Richard du Mesnil de Rochemont; Oliver C Singer; Reza Jahan Journal: N Engl J Med Date: 2015-04-17 Impact factor: 91.245
Authors: Bruce C V Campbell; Peter J Mitchell; Timothy J Kleinig; Helen M Dewey; Leonid Churilov; Nawaf Yassi; Bernard Yan; Richard J Dowling; Mark W Parsons; Thomas J Oxley; Teddy Y Wu; Mark Brooks; Marion A Simpson; Ferdinand Miteff; Christopher R Levi; Martin Krause; Timothy J Harrington; Kenneth C Faulder; Brendan S Steinfort; Miriam Priglinger; Timothy Ang; Rebecca Scroop; P Alan Barber; Ben McGuinness; Tissa Wijeratne; Thanh G Phan; Winston Chong; Ronil V Chandra; Christopher F Bladin; Monica Badve; Henry Rice; Laetitia de Villiers; Henry Ma; Patricia M Desmond; Geoffrey A Donnan; Stephen M Davis Journal: N Engl J Med Date: 2015-02-11 Impact factor: 91.245
Authors: Christian Maegerlein; Maria Teresa Berndt; Sebastian Mönch; Kornelia Kreiser; Tobias Boeckh-Behrens; Manuel Lehm; Silke Wunderlich; Claus Zimmer; Benjamin Friedrich Journal: Clin Neuroradiol Date: 2018-11-09 Impact factor: 3.649
Authors: Johannes Kaesmacher; Sebastian Bellwald; Tomas Dobrocky; Thomas R Meinel; Eike I Piechowiak; Martina Goeldlin; Christoph C Kurmann; Mirjam R Heldner; Simon Jung; Pasquale Mordasini; Marcel Arnold; Pascal J Mosimann; Gerhard Schroth; Heinrich P Mattle; Jan Gralla; Urs Fischer Journal: JAMA Neurol Date: 2020-03-01 Impact factor: 18.302
Authors: Ehsan Dowlati; Kwadwo Sarpong; Stanley Kamande; Austin H Carroll; Jerome Murray; Alynna Wiley; Brendon Peterson; Jeffrey C Mai; Jason J Chang; Edward F Aulisi; Rocco A Armonda; Daniel R Felbaum Journal: Neurol Sci Date: 2021-03-29 Impact factor: 3.307
Authors: Daniel Behme; Ioannis Tsogkas; Ruben Colla; Roland G Gera; Katharina Schregel; Amélie C Hesse; Ilko L Maier; Jan Liman; David S Liebeskind; Marios-Nikos Psychogios Journal: PLoS One Date: 2019-01-10 Impact factor: 3.240
Authors: Johannes Kaesmacher; Nuran Abdullayev; Basel Maamari; Tomas Dobrocky; Jan Vynckier; Eike I Piechowiak; Raoul Pop; Daniel Behme; Peter B Sporns; Hanna Styczen; Pekka Virtanen; Lukas Meyer; Thomas R Meinel; Daniel Cantré; Christoph Kabbasch; Volker Maus; Johanna Pekkola; Sebastian Fischer; Anca Hasiu; Alexander Schwarz; Moritz Wildgruber; David J Seiffge; Sönke Langner; Nicolas Martinez-Majander; Alexander Radbruch; Marc Schlamann; Dan Mihoc; Rémy Beaujeux; Daniel Strbian; Jens Fiehler; Pasquale Mordasini; Jan Gralla; Urs Fischer Journal: J Stroke Date: 2021-01-31 Impact factor: 6.967
Authors: Carlos Pérez-García; Christian Maegerlein; Santiago Rosati; Charlotte Rüther; Carlos Gómez-Escalonilla; Claus Zimmer; Juan Arrazola; Maria Teresa Berndt; Manuel Moreu Journal: Stroke Vasc Neurol Date: 2021-03-29