Abstract TP211: TICI Scoring Reliability in Proximal vs Distal Vessel Thrombectomy: A Comparative Analysis

Abstract

Introduction: The extended Thrombolysis in Cerebral Infarction (eTICI) scale has been demonstrated to correlate strongly with clinical outcomes. Thrombectomy has evolved into the pursuit of not only proximal but distal vessel occlusions, however the reliability of eTICI grading for distal occlusions has not been well studied. We aim to study the interrater agreement of proximal as compared to distal occlusions. Methods: A fellowship trained Neurointerventionalist retrospectively scored the Digital Subtraction Angiography(DSA) images of consecutive patients with only isolated proximal (MCA-M1 or ICA-T) or distal occlusions (MCA-M3, ACA, or PCA) that underwent MT at a single comprehensive stroke center (2022 for proximal occlusions and 2015-2022 for distals). We assessed the agreement between the Neurointerventionalist and original report for the ordinal eTICI scale using Fleiss-Cohen’s Weighted Kappa with quadratic weights. TICI distributions were compared using Wilcoxon’s rank sum test. Results: 187 patients were included in the analysis (124 Proximal and 60 patients distal: 32-M3, 20 -ACA, 8-PCA). The distribution of eTICI 0, 2a, 2b50, 2b67, 2c and 3 were comparable between proximal(MCA-M1 or ICA-T) vs distal occlusions (MCA-M3, ACA, or PCA). The Fleiss-Cohen weighted kappa coefficients were assessed. The proximal eTICI score assessment demonstrated moderate reliability with a kappa value of 0.77 (95%CI: 0.67-0.88)(Table 1A), while the distal eTICI score assessment exhibited almost perfect agreement with kappa value of 0.87 (95%CI: 0.71-1.00)(Table 1B). Conclusion: This study underscores comparable reliability of eTICI scores in assessing reperfusion post MT for distal as compared to proximal occlusions.