Division of Interventional Neuroradiology, Massachusetts General Hospital, Boston, MA, USA.
Stroke. 2013 Sep;44(9):2509-12. doi: 10.1161/STROKEAHA.113.001990. Epub 2013 Aug 6.
Angiographic revascularization grading after intra-arterial stroke therapy is limited by poor standardization, making it unclear which scale is optimal for predicting outcome. Using recently standardized criteria, we sought to compare the prognostic performance of 2 commonly used reperfusion scales.
Inclusion criteria for this multicenter retrospective study were acute ischemic stroke attributable to middle cerebral artery M1 occlusion, intra-arterial therapy, and 90-day modified Rankin scale score. Post-intra-arterial therapy reperfusion was graded using the Thrombolysis in Myocardial Infarction (TIMI) and Modified Thrombolysis in Cerebral Infarction (mTICI) scales. The scales were compared for prediction of clinical outcome using receiver-operating characteristic analysis.
Of 308 patients, mean age was 65 years, and median National Institutes of Health Stroke Scale score was 17. The mean time from stroke onset to groin puncture was 305 minutes. There was no difference in the time to treatment between patients grouped by final TIMI (ie, 0 versus 1 versus 2 versus 3) or mTICI grades (ie, 0 versus 1 versus 2a versus 2b versus 3). Good outcome (modified Rankin scale, 0-2) was achieved in 32.5% of patients, and mortality rate was 25.3% at 90 days. There was a 6.3% rate of parenchymal hematoma type 2. In receiver-operating characteristic analysis, mTICI was superior to TIMI for predicting 90-day modified Rankin scale 0 to 2 (c-statistic: 0.74 versus 0.68; P<0.0001). The optimal threshold for identifying a good outcome was mTICI 2b to 3 (sensitivity 78.0%; specificity 66.1%).
mTICI is superior to TIMI for predicting clinical outcome after intra-arterial therapy. mTICI 2b to 3 is the optimal biomarker for procedural success.
动脉内卒中治疗后的血管造影再通分级受到标准化程度的限制，因此不清楚哪种评分标准最适合预测结局。本研究采用最近标准化的标准，旨在比较两种常用再灌注评分的预后性能。
本多中心回顾性研究的纳入标准为急性缺血性卒中归因于大脑中动脉 M1 闭塞、动脉内治疗和 90 天改良 Rankin 量表评分。经动脉内治疗后的再灌注分级采用血栓溶解心肌梗死（TIMI）和改良血栓溶解脑梗死（mTICI）评分。采用受试者工作特征分析比较了两种评分对临床结局的预测价值。
308 例患者中，平均年龄为 65 岁，中位数国立卫生研究院卒中量表评分为 17 分。从卒中发病到股动脉穿刺的平均时间为 305 分钟。根据最终 TIMI（即 0 与 1 与 2 与 3）或 mTICI 分级（即 0 与 1 与 2a 与 2b 与 3）分组的患者之间，治疗时间无差异。32.5%的患者获得了良好结局（改良 Rankin 量表评分 0-2），90 天死亡率为 25.3%。有 6.3%的患者出现了 2 型脑实质血肿。在受试者工作特征分析中，mTICI 预测 90 天改良 Rankin 量表 0-2 的能力优于 TIMI（C 统计量：0.74 比 0.68；P<0.0001）。确定良好结局的最佳阈值为 mTICI 2b-3（敏感性 78.0%；特异性 66.1%）。
mTICI 预测动脉内治疗后临床结局优于 TIMI。mTICI 2b-3 是评估手术成功的最佳生物标志物。
