Abstract T MP7: TICI 2B vs. TICI 3: Differences in Infarct Volumes and Clinical Outcomes in Proximal Intracranial Large Vessel Occlusions Treated With Endovascular Therapy

Abstract

Introduction: Successful recanalization independently predicts good outcome following endovascular therapy for acute large vessel occlusions. Thrombolysis In Cerebral Infarction (TICI) status 2B (near-complete revascularization) and 3 (complete revascularization) are routinely combined to reflect successful recanalization. Whether outcomes in these two groups are truly comparable, has not been demonstrated. Methods: In a retrospective analysis of a prospectively collected patient cohort at our center (2008-2013), we identified adults with intracranial internal carotid and middle cerebral artery M1 occlusions who underwent endovascular therapy within 8 hours from symptom onset, achieved operator-measured TICI2B or TICI3 status and had a documented 90 day modified Rankin Score (mRS). Baseline characteristics (age, NIHSS score, time to groin puncture, ASPECTS, risk factors), final infarct volume, rate of good outcome (mRS 0-2), intracranial hemorrhage and mortality were assessed. Results: 99 patients (TICI2B:N=64, TICI 3:N=35, Median NIHSS 16, median ASPECTS 9) were included. No differences in baseline characteristics were identified (Figure A). Patients with TICI3 status had smaller final infarct volume (6.2cc vs. 22.5cc, p=0.007, Figure B), higher rate of good outcome (74.3% vs 45.3%, p=0.006), lower mortality (5.7% vs. 28.1%, p=0.008, Figure C) and similar hemorrhage rates (p=0.2) as compared to TICI2B. After controlling for age, NIHSS and ASPECTS, TICI3 status independently predicted good outcomes (OR 4.74 95%CI 1.53-14.67, p=0.007). Conclusions: Patients with TICI3 recanalization have smaller infarct volumes and better clinical outcomes as compared to TICI2B. With the improving efficiency of mechanical thrombectomy, future thrombectomy stroke trials should report TICI2B and TICI3 status separately.