Impact of expanded Thrombolysis in Cerebral Infarction (eTICI) grades on clinical outcomes in patients with large ischemic strokes receiving endovascular treatment.

OBJECTIVE

This study aimed to investigate the impact of the expanded Thrombolysis in Cerebral Infarction (eTICI) grades on clinical outcomes after endovascular treatment (EVT) for large ischemic strokes.

METHODS

This study was a substudy of a prospective nationwide multicenter registry that included 490 patients with large ischemic strokes undergoing EVT. The primary outcome was a 90-day modified Rankin Scale (mRS) score of 0-3. Secondary outcomes included the distribution of mRS score, and mRS scores of 0-2 and 0-4 at 90 days. Safety outcomes included 90-day mortality and symptomatic intracranial hemorrhage (sICH) within 48 h.

RESULTS

Among 490 patients treated with EVT, 67 (13.7%), 125 (25.5%), and 298 (60.8%) achieved eTICI grades 0-2a, 2b, and 2c-3, respectively. Compared with eTICI grades 0-2a, eTICI grade 2b showed no significant association with an mRS score of 0-3, while eTICI grades 2c-3 were significantly associated with higher odds of achieving an mRS score of 0-3 (adjusted odds ratios [aOR] 3.04, 95% CI 1.39-6.62). Mortality was lower for eTICI grades 2c-3 than for grades 0-2a (aOR 0.47, 95% CI 0.25-0.89). There were no significant differences in sICH rates among three groups. The predicted probability of an mRS score of 0-3 progressively decreased with increasing procedure time, while the predicted probability of mortality progressively increased.

CONCLUSION

In patients with large ischemic strokes undergoing EVT, eTICI grades 2c-3 were significantly associated with improved clinical outcomes. This study suggests that eTICI grades 2c-3 should be considered the ideal target for successful reperfusion in this patient population.