Abstract TMP4: TICI Chronology in ARISE II: Impact of Stepwise Reperfusion in Endovascular Therapy for Acute Ischemic Stroke

Abstract

Background: The severity and duration of ischemia determine the extent of injury in acute ischemic stroke (AIS). Rapid reperfusion in endovascular therapy is therefore linked with good outcomes, yet the chronology of reperfusion with subsequent device passes has not been fully explored. We tested whether the sequence of reperfusion after each interventional step or mTICI chronology, influences subsequent imaging and clinical outcomes after endovascular therapy for AIS. Methods: ARISE II dataset of clinical and angiography variables was analyzed to determine the relationship between sequential mTICI reperfusion scores with 90-day mRS outcomes. mTICI was scored at baseline and after each device pass. A Mantel-Haenszel chi-square p-value was calculated to measure the correlation between the total number of passes required and the mRS score at 90 days. Results: Core lab adjudicated mTICI scores on routine angiography injections were available in 227/227 (100%) of treated ARISE II subjects (age 68.0 ± 13.0, 54.2% women, mean baseline NIHSS 15.8 ± 5) and 90±30 day mRS scores were available for 217. The number of passes was highly correlated with mRS (p<0.001). The rate of mRS ≤ 2 at 90 days decreased with number of passes (81.3%, 71.1%, 52.1%, and 50.0% in patients with 1, 2, 3, and 4+ passes). Detailed modeling is in-process to explore the relationship between timing, number of passes, reperfusion and clinical outcome. Conclusions: mTICI chronology, or reperfusion at each procedural stage, varies in endovascular treatment of AIS and demonstrates an important link with outcomes.