Skip to main content

Advertisement

SpringerLink
Log in

Impact of Time on Thrombolysis in Cerebral Infarction Score Results

  • Original Article
  • Published:
Clinical Neuroradiology Aims and scope Submit manuscript

Abstract

Purpose

Extended thrombolysis in cerebral infarction (eTICI) score results of 2b or higher are known to be predictors for favorable outcome after acute stroke. Additionally, time is a major factor influencing outcome after ischemic stroke. Until today only little is known about the impact of time on angiographic results regarding the outcome after mechanical thrombectomy; however, this impact might be of interest if an initially unfavorable angiographic result has to be improved.

Methods

Retrospective study of 164 patients with large vessel occlusion of the anterior circulation treated by mechanical thrombectomy. Multiple logistic regression analysis of relevant periprocedural and procedural times in respect to the probability of achieving functional independence at 90 days in respect to different eTICI results was performed to build a time and TICI score-dependent model for outcome prediction in which the influence of time was assumed to be steady among the TICI grades.

Results

The probability of achieving a favorable outcome is significantly different between eTICI2b-50, 67, TICI2c and TICI3 results (p < 0.001). The odds for achieving a favorable outcome decrease over time and differ for each TICI category and time point. The individual odds for each patient, time point and TICI grade can be calculated based on this model.

Conclusion

The impact of periprocedural and procedural times and eTICI reperfusion results adds a new dimension to the decision-making process in patients with primary unfavorable angiographic results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Saver JL, Goyal M, van der Lugt A, Menon BK, Majoie CB, Dippel DW, Campbell BC, Nogueira RG, Demchuk AM, Tomasello A, Cardona P, Devlin TG, Frei DF, du Mesnil de Rochemont R, Berkhemer OA, Jovin TG, Siddiqui AH, van Zwam WH, Davis SM, Castaño C, Sapkota BL, Fransen PS, Molina C, van Oostenbrugge RJ, Chamorro Á, Lingsma H, Silver FL, Donnan GA, Shuaib A, Brown S, Stouch B, Mitchell PJ, Davalos A, Roos YB, Hill MD; HERMES Collaborators. Time to treatment with endovascular thrombectomy and outcomes from Ischemic stroke: a meta-analysis. JAMA. 2016;316:1279–88.

    Article  PubMed  Google Scholar 

  2. Behme D, Gondecki L, Fiethen S, Kowoll A, Mpotsaris A, Weber W. Complications of mechanical thrombectomy for acute ischemic stroke-a retrospective single-center study of 176 consecutive cases. Neuroradiology. 2014;56:467–76.

    Article  PubMed  Google Scholar 

  3. Spiotta AM, Vargas J, Turner R, Chaudry MI, Battenhouse H, Turk AS. The golden hour of stroke intervention: effect of thrombectomy procedural time in acute ischemic stroke on outcome. J Neurointerv Surg. 2014;6:511–6.

    Article  PubMed  Google Scholar 

  4. Zaidat OO, Yoo AJ, Khatri P, Tomsick TA, von Kummer R, Saver JL, Marks MP, Prabhakaran S, Kallmes DF, Fitzsimmons BF, Mocco J, Wardlaw JM, Barnwell SL, Jovin TG, Linfante I, Siddiqui AH, Alexander MJ, Hirsch JA, Wintermark M, Albers G, Woo HH, Heck DV, Lev M, Aviv R, Hacke W, Warach S, Broderick J, Derdeyn CP, Furlan A, Nogueira RG, Yavagal DR, Goyal M, Demchuk AM, Bendszus M, Liebeskind DS; Cerebral Angiographic Revascularization Grading (CARG) Collaborators; STIR Revascularization working group; STIR Thrombolysis in Cerebral Infarction (TICI) Task Force. Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement. Stroke. 2013;44:2650–63.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Kaesmacher J, Maegerlein C, Zibold F, Wunderlich S, Zimmer C, Friedrich B. Improving mTICI2b reperfusion to mTICI2c/3 reperfusions: a retrospective observational study assessing technical feasibility, safety and clinical efficacy. Eur Radiol. 2018;28:274–82.

    Article  PubMed  Google Scholar 

  6. Kleine JF, Wunderlich S, Zimmer C, Kaesmacher J. Time to redefine success? TICI 3 versus TICI 2b recanalization in middle cerebral artery occlusion treated with thrombectomy. J Neurointerv Surg. 2017;9:117–21.

    Article  PubMed  Google Scholar 

  7. Tung EL, McTaggart RA, Baird GL, Yaghi S, Hemendinger M, Dibiasio EL, Hidlay DT, Tung GA, Jayaraman MV. Rethinking thrombolysis in cerebral infarction 2b: which thrombolysis in cerebral infarction scales best define near complete recanalization in the modern Thrombectomy era? Stroke. 2017;48:2488–93.

    Article  PubMed  Google Scholar 

  8. Liebeskind DS, Bracard S, Guillemin F, Jahan R, Jovin TG, Majoie CB, Mitchell PJ, van der Lugt A, Menon BK, San Román L, Campbell BC, Muir KW, Hill MD, Dippel DW, Saver JL, Demchuk AM, Dávalos A, White P, Brown S, Goyal M; HERMES Collaborators. eTICI reperfusion: defining success in endovascular stroke therapy. J Neurointerv Surg. 2019;11:433-8.

    Article  PubMed  Google Scholar 

  9. Leyhe JR, Tsogkas I, Hesse AC, Behme D, Schregel K, Papageorgiou I, Liman J, Knauth M, Psychogios MN. Latest generation of flat detector CT as a peri-interventional diagnostic tool: a comparative study with multidetector CT. J Neurointerv Surg. 2017;9:1253-7.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Psychogios MN, Behme D, Schregel K, Tsogkas I, Maier IL, Leyhe JR, Zapf A, Tran J, Bähr M, Liman J, Knauth M. One-stop management of acute stroke patients: minimizing door-to-reperfusion times. Stroke. 2017;48:3152–5.

    Article  PubMed  Google Scholar 

  11. Behme D, Kowoll A, Mpotsaris A, Hader C, Hechelhammer L, Weber J, Weber W. Multicenter clinical experience in over 125 patients with the Penumbra Separator 3D for mechanical thrombectomy in acute ischemic stroke. J Neurointerv Surg. 2016;8:8–12.

    Article  PubMed  Google Scholar 

  12. Kowoll A, Weber A, Mpotsaris A, Behme D, Weber W. Direct aspiration first pass technique for the treatment of acute ischemic stroke: initial experience at a European stroke center. J Neurointerv Surg. 2016;8:230–4.

    Article  PubMed  Google Scholar 

  13. Maus V, Behme D, Kabbasch C, Borggrefe J, Tsogkas I, Nikoubashman O, Wiesmann M, Knauth M, Mpotsaris A, Psychogios MN. Maximizing first-pass complete reperfusion with SAVE. Clin Neuroradiol. 2018;28:327-38.

    Article  PubMed  Google Scholar 

  14. Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, Dávalos A, Majoie CB, van der Lugt A, de Miquel MA, Donnan GA, Roos YB, Bonafe A, Jahan R, Diener HC, van den Berg LA, Levy EI, Berkhemer OA, Pereira VM, Rempel J, Millán M, Davis SM, Roy D, Thornton J, Román LS, Ribó M, Beumer D, Stouch B, Brown S, Campbell BC, van Oostenbrugge RJ, Saver JL, Hill MD, Jovin TG; HERMES collaborators. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387:1723-31.

    Article  PubMed  Google Scholar 

  15. Maus V, Henkel S, Riabikin A, Riedel C, Behme D, Tsogkas I, Hesse AC, Abdullayev N, Jansen O, Wiesmann M, Mpotsaris A, Psychogios MN. The SAVE technique : large-scale experience for treatment of Intracranial large vessel occlusions. Clin Neuroradiol. 2018 Jul 19. doi: 10.1007/s00062-018-0702-4. [Epub ahead of print]

    Article  PubMed  Google Scholar 

  16. Kaesmacher J, Dobrocky T, Heldner MR, Bellwald S, Mosimann PJ, Mordasini P, Bigi S, Arnold M, Gralla J, Fischer U. Systematic review and meta-analysis on outcome differences among patients with TICI2b versus TICI3 reperfusions: success revisited. J Neurol. 2018;89:910–7.

    Article  Google Scholar 

  17. Mazighi M, Chaudhry SA, Ribo M, Khatri P, Skoloudik D, Mokin M, Labreuche J, Meseguer E, Yeatts SD, Siddiqui AH, Broderick J, Molina CA, Qureshi AI, Amarenco P. Impact of onset-to-reperfusion time on stroke mortality: a collaborative pooled analysis. Circulation. 2013;127:1980–5.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neuroradiology, University Medical Center Göttingen, Robert Koch Str. 40, 37099, Göttingen, Germany

    D. Behme, I. Tsogkas, R. Colla & M. N. Psychogios

  2. Department of Medical Statistics, University Medical Center Göttingen, 37075, Göttingen, Germany

    R. G. Gera

  3. Department of Neurology, University Medical Center Göttingen, 37075, Göttingen, Germany

    J. Liman & I. L. Maier

  4. Neurovascular Imaging Research Core and Stroke Center, Department of Neurology, UCLA, Los Angeles, CA, USA

    D. S. Liebeskind

Authors
  1. D. Behme
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. G. Gera
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. I. Tsogkas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Colla
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Liman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. I. L. Maier
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. D. S. Liebeskind
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. M. N. Psychogios
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. Behme.

Ethics declarations

Conflict of interest

D. Behme, R.G. Gera, I. Tsogkas, R. Colla, J. Liman, I.L. Maier, D.S. Liebeskind and M.N. Psychogios declare that they have no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Behme, D., Gera, R.G., Tsogkas, I. et al. Impact of Time on Thrombolysis in Cerebral Infarction Score Results. Clin Neuroradiol 30, 345–353 (2020). https://doi.org/10.1007/s00062-019-00786-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00062-019-00786-0

Keywords

Search

Navigation