The Clinical and Radiographic Importance of Distinguishing Partial from Near-Complete Reperfusion Following Intra-Arterial Stroke Therapy

M.V. Jayaraman; J.A. Grossberg; K.M. Meisel; A. Shaikhouni; B. Silver

doi:10.3174/ajnr.A3278

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Table 1:

Baseline demographics and clinical characteristics

	All Patients	By Final TICI Class			P Value
	All Patients	TICI 0/1	TICI 2a	TICI 2b/3	P Value
No. (%)	88	26 (29.6)	23 (26.1)	39 (44.3)
Age (mean)	68.2	68.9	68.1	67.9	.81
Sex (% female)	50%	57.70%	47.80%	46.10%	.68
History of hypertension	72.70%	65.40%	73.90%	76.90%	.62
Diabetes mellitus	28.40%	26.90%	21.70%	33.30%	.63
Coronary artery disease	25%	30.80%	30.40%	17.90%	.36
Atrial fibrillation	31.80%	23.10%	34.80%	35.90%	.58
Prior ischemic stroke	19.30%	15.40%	26.10%	17.90%	.63
Cigarette smoking within past 12 months	22.70%	23.10%	17.40%	25.60%	.77
Peripheral artery disease	9.10%	3.90%	8.70%	12.80%	.58
Mean admission NIHSS score	14.9	15.2	15.5	14.3	.83
Median admission NIHSS score	15	14.5	16	15	.83
Admission systolic BP (mm Hg, mean)	144.60	143.50	146.00	144.50	.87
Admission blood glucose (mg/dL, mean)	131.10	122.60	130.80	137.10	.51
Proximal occlusion (ICA or proximal M1 segment of MCA with lenticulostriate involvement)	51.10%	57.7%	65.2%	38.5%	.09
Time from symptom onset to angiography (min, mean)	288.80	302.3	299.6	272.7	.51

Note:—BP indicates blood pressure.

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Table 2:

Treatment details of intra-arterial therapy

Angiographic Parameters	No.	%
IV tPA given prior to IA therapy	14	15.9
Intubated at any point during angiography	3	3.4
Site of occlusion
ICA	22	25.0
M1, proximal (involves lenticulostriates)	23	26.1
M1, distal (spares lenticulostriates)	16	18.2
M2	25	28.4
M3	2	2.3
Concomitant cervical segment ICA stenosis (>70%) or occlusion	16	18.2
Treatment
Thrombolytic infusion alone	65	73.9
Mechanical thrombectomy alone	4	4.5
Both MT and IAT	19	21.6
Intracranial stent placement	4	4.5

Note:—IA indicates intra-arterial; MT, mechanical thrombectomy.

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Table 3:

Discharge disposition by TICI class and infarct volume

	Home	Rehab	Death/Hospice	P Value
All Patients	25%	48.9%	26.1%
By TICI class
TICI 0/1	7.7%	57.7%	34.6%	.0084
TICI 2a	17.4%	43.5%	39.1%
TICI 2b/3	41.0%	46.2%	12.8%
By infarct volume
Infarct volume ≤70 mL	36%	50%	14%
Infarct volume >70 mL	0%	38%	63%

Note:—Rehab indicates rehabilitation.

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Table 4:
Odds ratios for final infarct volume <70 mL by final reperfusion class, compared with TICI 0/1 reperfusion
OR Compared with TICI 0/1 for Final Infarct Volume <70 mL (95% CI)
TICI 2b/3 reperfusion 12.1 (2.7–54.2)
TICI 2a or 2b/3 reperfusion (any reperfusion) 6.79 (1.8–25.2)
TICI 2a reperfusion 2.2 (0.5–9.6)

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Table 5:

Odds ratios for discharge home and in-hospital mortality comparing various reperfusion groups versus TICI 0/1, for all patients and those with ICA and M1 occlusions only

	All Patients (n = 88)		ICA, M1 Only (n = 61)
	OR	95% CI	OR	95% CI
OR for discharge home
TICI 2a vs 0/1	2.52	(0.41–15.2)	N/A^{^a}
TICI 2b/3 vs 2a	3.30	(0.94–11.56)	5.18	(0.99–27.07)
TICI 2b/3 vs 0–2a	4.99^{^b}	(1.72–14.48)^{^b}	10.03	(1.99–50.51)^{^b}
OR for in-hospital mortality
TICI 2a vs 0/1	1.21	(0.38–3.88)	0.88	(0.22–3.45)
TICI 2b/3 vs 2a	0.23^{^b}	(0.07–0.81)^{^b}	0.17	(0.04–0.68)^{^b}
TICI 2b/3 vs 0–2a	0.25^{^b}	(0.08–0.76)^{^b}	0.16	(0.04–0.55)^{^b}

↵a N/A indicates that no patients with ICA or M1 occlusion with TICI 0/1 reperfusion were discharged home in this series.
↵b Comparisons in which the 95% confidence interval does not cross 1.0 are considered significant.