Abstract
Background and Purpose: Successful reperfusion therapy is supposed to be comprehensive and validated beyond the grade of recanalization. This study aimed to develop a novel scoring system for defining the successful recanalization after endovascular thrombectomy.Methods: We analyzed the data of consecutive acute stroke patients who were eligible to undergo reperfusion therapy within 24 h of onset and who underwent mechanical thrombectomy using a nationwide multicenter stroke registry. A new score was produced using the predictors which were directly linked to the procedure to evaluate the performance of the thrombectomy procedure.Results: In total, 446 patients in the training population and 222 patients in the validation population were analyzed. From the potential components of the score, four items were selected: Emergency Room-to-puncture time (T), adjuvant devices used (A), procedural intracranial bleeding (B), and post-thrombectomy reperfusion status [Thrombolysis in Cerebral Infarction (TICI)]. Using these items, the TAB-TICI score was developed, which showed good performance in terms of discriminating early neurological aggravation [AUC 0.73, 95% confidence interval (CI) 0.67–0.78, P < 0.01] and favorable outcomes (AUC 0.69, 95% CI 0.64–0.75, P < 0.01) in the training population. The stability of the TAB-TICI score was confirmed by external validation and sensitivity analyses. The TAB-TICI score and its derived grade of successful recanalization were significantly associated with the volume of thrombectomy cases at each site and in each admission year.Conclusion: The TAB-TICI score is a valid and easy-to-use tool to more comprehensively define successful recanalization after endovascular thrombectomy in acute stroke patients with large vessel occlusion.
Highlights
The stability of the TAB-Thrombolysis in Cerebral Infarction (TICI) score was confirmed by external validation and sensitivity analyses
The TAB-TICI score and its derived grade of successful recanalization were significantly associated with the volume of thrombectomy cases at each site and in each admission year
Endovascular thrombectomy (EVT) with substantial recanalization is a crucial determinant of the functional independence of acute stroke patients with large vessel occlusion (LVO) [1]
Summary
Endovascular thrombectomy (EVT) with substantial recanalization is a crucial determinant of the functional independence of acute stroke patients with large vessel occlusion (LVO) [1]. To obtain the maximum benefit, current guidelines recommend achieving modified Thrombolysis in Cerebral Infarction (mTICI) 2b or 3 grade angiographic results as a technical goal of EVT [1]. This substantial reperfusion is often regarded as a successful recanalization therapy. Performance of procedures in patients with failed reperfusion should be further stratified, suggesting the need for a comprehensive evaluation tool for successful thrombectomy. This study aimed to develop a novel scoring system for defining the successful recanalization after endovascular thrombectomy
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