review · Journal of NeuroInterventional Surgery
Endovascular thrombectomy is commonly considered technically successful when achieving a Thrombolysis in Cerebral Infarction (TICI) revascularisation score of 2b or higher. A systematic review and network meta-analysis evaluated forty studies encompassing 8,691 acute ischaemic stroke patients to investigate the link between specific revascularisation grades and functional independence at ninety days. The quantitative synthesis demonstrated that patients achieving complete TICI 3 recanalisation experienced the highest rates of good functional recovery, closely followed by those reaching TICI 2c, and then TICI 2b. Furthermore, functional recovery rates were comparable between patients achieving TICI 2c and TICI 3 grades across different scoring systems. Additional analysis revealed equivalent functional outcomes between expanded TICI 2b50 and 2b67 categories. Achieving near complete or complete blood flow restoration, defined as TICI 2c or 3, correlates with the best functional recovery following thrombectomy.
Evaluating stroke intervention success has historically grouped several degrees of restored blood flow together. Establishing that near complete or complete vessel reopening yields superior recovery compared to partial success helps clinicians refine benchmarks for procedural efficacy. Clarifying the direct link between distinct revascularisation levels and patient independence at three months aids medical teams in setting precise targets during acute stroke procedures.
These findings can guide medical device developers, interventional neuroradiologists, and clinical trial designers evaluating stroke thrombectomy tools. Clearer evidence linking TICI 2c and 3 revascularisation to recovery supports using stricter procedural endpoints in clinical trials and device validation. While the clinical evidence is derived from existing patient datasets, the abstract does not indicate a direct commercial product pathway beyond informing procedural evaluation and clinical study designs.
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Most studies define the technical success of endovascular thrombectomy (EVT) as a Thrombolysis in Cerebral Infarction (TICI) revascularization grade of 2b or higher. However, growing evidence suggests that TICI 3 is the best angiographic predictor of improved functional outcomes. To assess the association between successful TICI revascularization grades and functional independence at 90 days, we performed a systematic review and network meta-analysis of thrombectomy studies that reported TICI scores and functional outcomes, measured by the modified Rankin Scale, using the semi-automated AutoLit software platform. Forty studies with 8691 patients were included in the quantitative synthesis. Across TICI, modified TICI (mTICI), and expanded TICI (eTICI), the highest rate of good functional outcomes was observed in patients with TICI 3 recanalization, followed by those with TICI 2c and TICI 2b recanalization, respectively. Rates of good functional outcomes were similar among patients with either TICI 2c or TICI 3 grades. On further sensitivity analysis of the eTICI scale, the rates of good functional outcomes were equivalent between eTICI 2b50 and eTICI 2b67 (OR 0.81, 95% CI 0.52 to 1.25). We conclude that near complete or complete revascularization (TICI 2c/3) is associated with higher rates of functional outcomes after EVT.
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DOI: 10.1136/neurintsurg-2021-018436
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