Abstract
A mTICI 2b or a mTICI 3 score are currently considered success following mechanical thrombectomy (MT) in acute stroke but is undetermined whether the two scores translate equivalent outcomes. We present a single-center, retrospective cohort of patients with anterior circulation stroke treated with MT and achieving a final mTICI score 2b or 3. A multimodal CT at baseline and a multimodal MRI at 24 hours assessed the growth of the infarct, and the modified Rankin Scale (mRS) assessed functional outcome at 90 days. The primary outcome was the shift analysis of the mRS at day 90 in ordinal regression adjusted for covariates (age, sex, pretreatment NIHSS score, target occlusion, infarct core, pretreatment alteplase), and the collateral score. Infarct growth was explored in a similarly adjusted multiple linear regression model. MT was started within a median of 285 minutes of symptom onset; 51 (41%) patients achieved a mTICI 2b, and 74 (59%), a mTICI 3. mTICI 3 resulted in better mRS score transitions than mTICI 2b (odds ratio 2.018 [95% CI 1.033–3.945], p = 0. 040), and reduced infarct growth (p = 0.002). We conclude that in patients with acute stroke receiving MT, success should be redefined as achieving a mTICI 3 score.
Highlights
A Modified Treatment In Cerebral Ischemia (mTICI) 2b or a mTICI 3 score are currently considered success following mechanical thrombectomy (MT) in acute stroke but is undetermined whether the two scores translate equivalent outcomes
Bleeding complications were scored on CT or MRI according to the European Cooperative Acute Stroke Study (ECASS) criteria[21], and symptomatic intracerebral hemorrhage defined the presence of blood on brain imaging associated with an increment of at least 4 points in the National Institute of Health Stroke Scale (NIHSS) score
Recanalization of the local occlusion occurred within a median (IQR) of 285 (210–369) minutes of symptom onset; 51 (41%) patients achieved a mTICI 2b score and 74 (59%) patients a mTICI 3 score
Summary
A mTICI 2b or a mTICI 3 score are currently considered success following mechanical thrombectomy (MT) in acute stroke but is undetermined whether the two scores translate equivalent outcomes. The Modified Treatment In Cerebral Ischemia (mTICI) is recommended as the primary reperfusion scale to assess the therapeutic intervention in patients receiving MT for it was designed for the cerebral circulation, has good inter-rater reliability, and strongly predicts clinical outcome[6, 7]. In this scale, mTICI score 3 defines complete reperfusion of the target downstream territory (TDT) and mTICI 2b score defines restoration of more than half of the TDT8, 9. Recent observations suggested conflicting results in MT-treated patients, for mTICI www.nature.com/scientificreports/
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