Tung Eric L, McTaggart Ryan A, Baird Grayson L, Yaghi Shadi, Hemendinger Morgan, Dibiasio Eleanor L, Hidlay Douglas T, Tung Glenn A, Jayaraman Mahesh V
From the Department of Diagnostic Imaging (E.L.T., R.A.M., G.L.B., E.L.D., D.T.H., G.A.T., M.V.J.), Neurology (R.A.M., S.Y., M.H., M.V.J.), and Neurosurgery (R.A.M., M.V.J.), Warren Alpert School of Medicine at Brown University Providence, RI; and Norman Prince Neuroscience Institute (R.A.M., S.Y., G.A.T., M.V.J.) and Lifespan Biostatistics Core (G.L.B.), Rhode Island Hospital.
Stroke. 2017 Sep;48(9):2488-2493. doi: 10.1161/STROKEAHA.117.017182. Epub 2017 Aug 3.
Within the thrombolysis in cerebral infarction (TICI) classification, TICI 2b has been historically considered successful recanalization. Recent studies have suggested that TICI 3 and a proposed TICI 2c should be separately reported from TICI 2b, in both the original (>66% reperfusion) and modified (>50% reperfusion) definitions, because of differences in clinical outcomes with greater reperfusion. The purpose of this study was to evaluate differences in early neurological improvement and independence at 90 days using the original TICI, modified TICI, and modified TICI with 2c scales.
A retrospective review of 129 consecutive patients with middle cerebral artery, M1 segment or intracranial internal carotid artery occlusions. Patient angiograms were graded by 2 experienced readers by percentage recanalization. This was then categorized into original TICI, modified TICI (mTICI), and mTICI with TICI 2c (mTICI 2c) grading scales. Comparison of baseline demographics, early neurological improvement, and independence at 90 days was performed.
A significant difference in early neurological improvement was observed between 2b and 3 (=0.032), as well as between 2b and 2c (=0.028) under the mTICI 2c grading scale. Similarly, a significant difference in functional independence was observed between 2b and 3 (=0.037), as well as between 2b and 2c (=0.047) under the mTICI 2c scale. The difference in early neurological improvement or functional independence between 2b and 3 for the original TICI and mTICI scales was not significant. When combining the 2c and 3 groups under the mTICI 2c scale, there were significant differences between 2b and 2c/3 in regards to both early neurological improvement (=0.011) and independence (=0.018).
Using a TICI grading system that includes an additional category beyond TICI 2b allows for refined prediction of early neurological improvement and functional independence.
在脑梗死溶栓（TICI）分类中，TICI 2b一直以来都被视为成功再通。近期研究表明，由于再灌注程度更高会导致临床结局存在差异，因此在原始定义（>66%再灌注）和修订定义（>50%再灌注）中，TICI 3和提议的TICI 2c都应与TICI 2b分开报告。本研究的目的是使用原始TICI、修订TICI以及带有2c分级的修订TICI来评估90天时早期神经功能改善和独立性的差异。
对129例连续的大脑中动脉M1段或颅内颈内动脉闭塞患者进行回顾性研究。由2名经验丰富的阅片者根据再通百分比对患者血管造影进行分级。然后将其分为原始TICI、修订TICI（mTICI）以及带有TICI 2c的mTICI（mTICI 2c）分级量表。对基线人口统计学、早期神经功能改善以及90天时的独立性进行比较。
在mTICI 2c分级量表下，观察到2b与3之间早期神经功能改善存在显著差异（P=0.032），2b与2c之间也存在显著差异（P=0.028）。同样，在mTICI 2c量表下，观察到2b与3之间功能独立性存在显著差异（P=0.037），2b与2c之间也存在显著差异（P=0.047）。原始TICI和mTICI量表中2b与3之间在早期神经功能改善或功能独立性方面的差异不显著。在mTICI 2c量表下将2c和3组合并时，2b与2c/3在早期神经功能改善（P=0.011）和独立性（P=0.018）方面均存在显著差异。
使用包含TICI 2b以外额外分类的TICI分级系统能够更精确地预测早期神经功能改善和功能独立性。
