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Clarifying Differences Among Thrombolysis in Cerebral Infarction Scale Variants: Is the Artery Half Open or Half Closed?

 Sang Hyun Suh  ;  Harry J. Cloft  ;  Jennifer E. Fugate  ;  Alejandro A. Rabinstein  ;  David S. Liebeskind  ;  David F. Kallmes 
 STROKE, Vol.44(4) : 1166-1168, 2013 
Journal Title
Issue Date
Aged ; Angiography/methods ; Arteries/pathology* ; Cerebral Infarction/diagnosis* ; Cerebral Infarction/physiopathology* ; Female ; Fibrinolytic Agents/pharmacology ; Humans ; Male ; Middle Aged ; Models, Statistical ; Neurology/methods ; Observer Variation ; Perfusion ; Radiology/methods ; Reperfusion ; Reproducibility of Results ; Stroke/therapy ; Thrombolytic Therapy/methods* ; Treatment Outcome
interobserver variability ; TICI ; thrombolytic therapy ; stroke ; reperfusion
BACKGROUND AND PURPOSE: Although thrombolysis in cerebral infarction (TICI) 2b/3 has been regarded as a successful angiographic outcome, the definition or subclassification of TICI 2 has differed between the original (o-TICI) and modified TICI (m-TICI). We sought to compare interobserver variability for both scores and analyze the subgroups of the TICI 2. METHODS: Five readers interpreted angiographies independently using a 6-point scale as follows: grade 0, no antegrade flow; grade 1, flow past the initial occlusion without tissue reperfusion; grade 2, partial reperfusion in <50% of the affected territory; grade 3, partial reperfusion in 50% to 66%; grade 4, partial reperfusion in ≥ 67%; grade 5, complete perfusion. Readings using this scale were then converted into o-TICI and m-TICI score. Statistical analysis was performed according to TICI 2 subgroups. RESULTS: Interobserver agreement was good for the o-TICI and m-TICI scores (intraclass correlation coefficient, 0.73 and 0.67, respectively). Our grade 3 (partial perfusion with 50% to 66%) occupied 19% of total readings, which would have been classified as grade 2a in o-TICI, but as 2b in m-TICI. The m-TICI was more likely to predict good clinical outcome than o-TICI (odds ratio, 2.01 versus 1.63, in reads with TICI 2b/3 versus 0/2a). CONCLUSIONS: Both TICI scales showed good agreement among readers. However, the variability in partial perfusion thresholds leads to different grading in ≈ 20% of cases and may result in significantly different rates of accurate outcome prediction.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Suh, Sang Hyun(서상현) ORCID logo https://orcid.org/0000-0002-7098-4901
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