van der Sluijs P Matthijs, Su Ruisheng, Cornelissen Sandra, van Es Adriaan C G M, Lycklama A Nijeholt Geert J, van Doormaal Pieter Jan, van Zwam Wim H, Dippel Diederik W J, van Walsum T, van der Lugt Aad
Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands.
J Neurointerv Surg. 2025 Jan 26. doi: 10.1136/jnis-2024-021892.
The extended Thrombolysis in Cerebral Infarction (eTICI) score is used in digital subtraction angiography (DSA) to quantify reperfusion grade in patients with an ischemic stroke who undergo endovascular thrombectomy (EVT). A previously developed automatic TICI score (autoTICI), which quantifies the ratio of reperfused pixels after EVT, demonstrates good correlation with eTICI.
To evaluate the autoTICI model in a large multicenter registry of patients with an ischemic stroke, investigate the association with visual eTICI, and compare prediction of functional outcome between autoTICI and eTICI.
Patients in the MR CLEAN Registry with an internal carotid artery, M1, and M2 occlusion were selected if both anteroposterior and lateral views were present in pre- and post-EVT DSA scans. The autoTICI score was compared with eTICI in predicting favorable functional outcome (modified Rankin Scale score 0-2), using area under the receiver operating characteristics curve (AUC) with a multivariable logistic regression model including known prognostic characteristics.
In total 421 of 3637 patients were included. AutoTICI was significantly associated with eTICI non-linearly (below 70% cOR=2.3 (95% CI 2.1 to 2.5), above 70% cOR=1.6 (95% CI 1.6 to 1.7) per 10% increment). The AUC of the model predicting favorable functional outcome was similar for autoTICI and eTICI (0.86, 95% CI 0.82 to 0.92 vs 0.86, 95% CI 0.83 to 0.90, P=0.73) and was higher than for a model with prognostic patient characteristics alone (0.86 vs 0.84, P=0.01).
Automatic quantitative assessment of reperfusion after EVT is associated with eTICI, and prediction of functional outcome is similar to that with visual eTICI. Therefore, autoTICI could be used as an alternative or additional review for visual reperfusion assessment to facilitate reproducible and uniform reporting.
脑梗死溶栓扩展（eTICI）评分用于数字减影血管造影（DSA），以量化接受血管内血栓切除术（EVT）的缺血性中风患者的再灌注等级。先前开发的自动TICI评分（autoTICI）可量化EVT后再灌注像素的比例，与eTICI具有良好的相关性。
在大型多中心缺血性中风患者登记处评估autoTICI模型，研究其与视觉eTICI的关联，并比较autoTICI和eTICI对功能结局的预测。
如果在EVT前和后DSA扫描中同时存在前后位和侧位视图，则选择MR CLEAN登记处中患有颈内动脉、M1和M2闭塞的患者。使用受试者工作特征曲线下面积（AUC）和包含已知预后特征的多变量逻辑回归模型，比较autoTICI评分与eTICI在预测良好功能结局（改良Rankin量表评分0-2）方面的差异。
总共纳入了3637例患者中的421例。AutoTICI与eTICI呈非线性显著相关（低于70%时，每增加10%，校正比值比[cOR]=2.3（95%可信区间[CI]2.1至2.5）；高于70%时，cOR=1.6（95%CI 1.6至1.7））。预测良好功能结局的模型的AUC，autoTICI和eTICI相似（0.86，95%CI 0.8 to 0.92对0.86，95%CI 0.83至0.90，P=0.73），且高于仅具有患者预后特征的模型（0.86对0.84，P=0.01）。
EVT后再灌注的自动定量评估与eTICI相关，且对功能结局的预测与视觉eTICI相似。因此，autoTICI可作为视觉再灌注评估的替代或补充检查，以促进可重复和统一的报告。
