Abstract 63: Correlation of AOL Recanalization, TIMI Reperfusion and TICI Reperfusion with Infarct Growth and Clinical Outcome in the DEFUSE 2 Trial

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Objective: To understand how three commonly utilized angiographic outcome measures of endovascular therapy correlate with clinical outcome and infarct growth in acute stroke patients. Methods: Prospectively enrolled patients with anterior circulation strokes underwent baseline MRI and started endovascular therapy within 12 hours of stroke onset. The final angiogram was given a recanalization score of the primary arterial occlusive lesion- AOL (0-3), a Thrombolysis in Myocardial Infarct (TIMI) Score (0-3) and a Thrombolysis in Cerebral Infarction (TICI) Score (0-3) using previously described definitions. TICI 2 scores were divided into partial reperfusion < 50% (TICI 2a) and > 50% (TICI 2b). Scores were dichotomized into poor recanalization or reperfusion (AOL 0-2, TIMI 0-1 and TICI 0-2a) versus good (AOL 3, TIMI 2-3, TICI 2b-3). Patients were classified as Target Mismatch (TMM) if: PWI (Tmax>6s) / DWI >1.8, (Tmax>6)-DWI>15ml, DWI <70mL, and PWI (Tmax>10s) <100mL. Good functional outcome (GFO) was a 90 day mRS of 0-2. Results: There were 99 patients with endovascular treatment and adequate baseline MR data. Following therapy, 46% were TICI 2b-3, 76% TIMI 2-3 and 59% had an AOL score of 3. TICI scores correlated with GFO (p=0.009). In TMM patients, 63% with TICI 2b-3 reperfusion had GFO, versus 28% of TICI 0-2a (p=0.003). Patients with TICI 2a had only a 36% rate of GFO. Overall TIMI scores also correlated with GFO at 90 days, p=0.036. In TMM patients, 54% with TIMI 2-3 had GFO, versus 16% of TIMI 0-1 patients (p=0.007). AOL recanalization scores did not correlate with GFO, nor did the dichotomized scores in TMM patients. Median lesion growth was 23 ml (IQR, 6-69) for TICI 2b-3 patients versus 80 ml (39-159) for TICI 0-2a, p<0.001. Considered separately, TICI 2a patients had more growth, 86 ml (21-178), than TICI 2b-3 patients (p=0.003). Median lesion growth was 41 ml (IQR, 8-93) for TIMI 2-3 patients versus 68 (45-127) for TIMI 0-1 patients, p=0.024. Conclusion: TIMI and TICI reperfusion scores identified Target Mismatch patients with good functional outcome. The AOL recanalization score did not. The TICI 2a patients had poorer outcome and more lesion growth than TICI 2b-3 patients.