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Research ArticleINTERVENTIONAL

Revascularization Results in the Interventional Management of Stroke II Trial

T. Tomsick, J. Broderick, J. Carrozella, P. Khatri, M. Hill, Y. Palesch and J. Khoury for the Interventional Management of Stroke II Investigators
American Journal of Neuroradiology March 2008, 29 (3) 582-587; DOI: https://doi.org/10.3174/ajnr.A0843
T. Tomsick
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J. Broderick
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J. Carrozella
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P. Khatri
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M. Hill
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Y. Palesch
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J. Khoury
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    Fig 1.

    Patient flow and treatment group designation for 81 subjects entered into IMS II.

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    Fig 2.

    Graph depicts total cumulative complete grade 3 AOL recanalization at each 15-minute interval for the EKOS Primo sonography microcatheter (n = 29) and the standard microcatheter in IMS II (n = 14). Standard microcatheter recanalization data points at 60 and 120 minutes are also depicted. IMS I data are incomplete at 60 minutes, with 23 confirmed control arteriograms. Sixty- and 120-minute IMS I data points closely approximate the line of IMS II microcatheter recanalization. The open circle emphasizes an early equivalence of standard microcatheter to the sonography (US) microcatheter. The greatest recanalization effect (>20%) is within the first 15 minutes of microcatheter placement.

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    Fig 3.

    Temperature (T) chart correlation to recanalization in M2 occlusion. Upper left: control arteriogram demonstrates EKOS sonography microcatheter placed in the M2 occlusion (white arrow) just before treatment time 0. Upper right: 15-minute control arteriogram demonstrates microcatheter tip retraction into the M1 segment (white arrow). Note the temperature decrease of approximately 0.2°C during the 15-minute time interval, indicating cooling of the catheter by flowing blood. Lower right: oblique 30-minute arteriogram with catheter-tip position (white arrow) proximal to recanalization of the M2 segment, with distal emboli (AOL 3 recanalization, TICI 2 perfusion). Note the temperature drop of approximately 0.4°C during the 15-minute time interval. The downward spikes of T indicate cooling by contrast injection. The spike at 25 minutes was an additional injection to confirm maintenance of catheter position, where no recanalization was yet identified. deg C indicates degrees celsius.

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    Table 1:

    Terminology and definition of TICI reperfusion (I) and AOL recanalization scores (II)*

    Terminology and Definition
    1. Posttreatment TICI reperfusion grade

      0 = No perfusion

      1 = Perfusion past the initial obstruction but limited distal branch filling with little or slow distal perfusion

      2A = Perfusion of less than half of the vascular distribution of the occluded artery (eg, filling and perfusion through 1 M2 division)

      2B = Perfusion of half or greater of the vascular distribution of the occluded artery (eg, filling and perfusion through 2 or more M2 divisions)

      3 = Full perfusion with filling of all distal branches

    2. Posttreatment AOL recanalization grade

      0 = No recanalization of the occlusion

      1 = Incomplete or partial recanalization of the occlusion, with no distal flow

      2 = Incomplete or partial recanalization of the occlusion, with any distal flow

      3 = Complete recanalization of the occlusion with any distal flow

    • * The modified TICI reperfusion score was essentially equivalent to TIMI score applied in IMS I, with grade 2 further divided into A and B for post hoc analysis.

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    Table 2:

    mRS 0–2 outcomes and mortality with 75 ICA T (n = 29) M1 (n = 46) occlusions according to TICI reperfusion and AOL recanalization in IMS I and II*

    mRS 0–2Mortality
    IMS IIMS IITotal I & IIIMS IIMS IITotal I & II
    TICI 2/310/25 (40%)11/21 (52.4%)21/46 (45.6%)P = .00044/25 (20%)1/21 (4.7 %)5/46 (10.9%)P = .01
    No TICI 2/30/16 (0%)2/13 (15.4%)2/29 (6.9 %)5/16 (31.3%)5/13 (38.4%)10/29 (34.5%)
    TICI 2B, 37/15 (46.7%)8/11 (72.7%)15/26 (57.7%)P = .00022/15 (13.3%)0/11 (0%)2/26 (7.7%)P = .05
    No TICI 2B, 33/26 (11.5%)5/23 (21.7 %)8/49 (16.3 %)7/26 (25.9%)6/23 (26.1%)13/49 (26.5%)
    AOL 2/310/30 (34.5%)11/26 (42.3%)21/56 (37.5%)P = .0275/30 (16.6%)3/26 (11.5%)8/56 (14.3%)P = .03
    No AOL 2/30/11 (0%)2/8 (25%)2/19 (10.5%)4/11 (36.3%)3/8 (37.5%)7/19 (36.8%)
    Overall10/41 (24.4%)13/34 (38.2%)23/75 (30.6%)9/41 (21.9%)6/34 (17.6%)15/75 (20%)
    • * These data includes 25 (33%) subjects with ICA bifurcation occlusion or stenosis ≥ 70%. Statistical comparisons of 3 dichotomized revascularization end points are included.

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American Journal of Neuroradiology: 29 (3)
American Journal of Neuroradiology
Vol. 29, Issue 3
March 2008
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Revascularization Results in the Interventional Management of Stroke II Trial
T. Tomsick, J. Broderick, J. Carrozella, P. Khatri, M. Hill, Y. Palesch, J. Khoury
American Journal of Neuroradiology Mar 2008, 29 (3) 582-587; DOI: 10.3174/ajnr.A0843

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Revascularization Results in the Interventional Management of Stroke II Trial
T. Tomsick, J. Broderick, J. Carrozella, P. Khatri, M. Hill, Y. Palesch, J. Khoury
American Journal of Neuroradiology Mar 2008, 29 (3) 582-587; DOI: 10.3174/ajnr.A0843
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