Article Figures & Data
Figures
- Fig 1.
Patient flow and treatment group designation for 81 subjects entered into IMS II.
- 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.
- 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.
Tables
- Table 1:
Terminology and definition of TICI reperfusion (I) and AOL recanalization scores (II)*
Terminology and Definition 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
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.
- 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 0–2 Mortality IMS I IMS II Total I & II IMS I IMS II Total I & II TICI 2/3 10/25 (40%) 11/21 (52.4%) 21/46 (45.6%) P = .0004 4/25 (20%) 1/21 (4.7 %) 5/46 (10.9%) P = .01 No TICI 2/3 0/16 (0%) 2/13 (15.4%) 2/29 (6.9 %) 5/16 (31.3%) 5/13 (38.4%) 10/29 (34.5%) TICI 2B, 3 7/15 (46.7%) 8/11 (72.7%) 15/26 (57.7%) P = .0002 2/15 (13.3%) 0/11 (0%) 2/26 (7.7%) P = .05 No TICI 2B, 3 3/26 (11.5%) 5/23 (21.7 %) 8/49 (16.3 %) 7/26 (25.9%) 6/23 (26.1%) 13/49 (26.5%) AOL 2/3 10/30 (34.5%) 11/26 (42.3%) 21/56 (37.5%) P = .027 5/30 (16.6%) 3/26 (11.5%) 8/56 (14.3%) P = .03 No AOL 2/3 0/11 (0%) 2/8 (25%) 2/19 (10.5%) 4/11 (36.3%) 3/8 (37.5%) 7/19 (36.8%) Overall 10/41 (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.
In this issue
Jump to section
Related Articles
Cited By...
- Automated ASPECTS in Acute Ischemic Stroke: A Comparative Analysis with CT Perfusion
- Electronic Alberta Stroke Program Early CT score change and functional outcome in a drip-and-ship stroke service
- Exploring the relationship between ischemic core volume and clinical outcomes after thrombectomy or thrombolysis
- Influence of occlusion site and baseline ischemic core on outcome in patients with ischemic stroke
- Susceptibility vessel sign on MRI predicts better clinical outcome in patients with anterior circulation acute stroke treated with stent retriever as first-line strategy
- First-in-man experience of the Versi Retriever in acute ischemic stroke
- Thrombectomy using the EmboTrap device: core laboratory-assessed results in 201 consecutive patients in a real-world setting
- Mechanical thrombectomy and rescue therapy for intracranial large artery occlusion with underlying atherosclerosis
- Clinical Outcomes of Endovascular Treatment within 24 Hours in Patients with Mild Ischemic Stroke and Perfusion Imaging Selection
- Intravenous Recombinant Tissue-Type Plasminogen Activator: Influence on Outcome in Anterior Circulation Ischemic Stroke Treated by Mechanical Thrombectomy
- Indications for the Performance of Intracranial Endovascular Neurointerventional Procedures: A Scientific Statement From the American Heart Association
- MR Perfusion to Determine the Status of Collaterals in Patients with Acute Ischemic Stroke: A Look Beyond Time Maps
- Endovascular treatment for AIS with underlying ICAD
- The Impact of Conscious Sedation versus General Anesthesia for Stroke Thrombectomy on the Predictive Value of Collateral Status: A Post Hoc Analysis of the SIESTA Trial
- Multiparametric Magnetic Resonance Imaging for Prediction of Parenchymal Hemorrhage in Acute Ischemic Stroke After Reperfusion Therapy
- Time to redefine success? TICI 3 versus TICI 2b recanalization in middle cerebral artery occlusion treated with thrombectomy
- Endovascular Therapy of M2 Occlusion in IMS III: Role of M2 Segment Definition and Location on Clinical and Revascularization Outcomes
- Impact of Modified TICI 3 versus Modified TICI 2b Reperfusion Score to Predict Good Outcome following Endovascular Therapy
- Emergent mechanical thrombectomy for acute stroke using the Mindframe Capture LP system: initial single-center experience
- A Direct Aspiration, First Pass Technique (ADAPT) versus Stent Retrievers for Acute Stroke Therapy: An Observational Comparative Study
- Impact of Target Arterial Residual Stenosis on Outcome After Endovascular Revascularization
- TICI and Age: What's the Score?
- Imaging Findings Associated with Space-Occupying Edema in Patients with Large Middle Cerebral Artery Infarcts
- Effect of endovascular reperfusion in relation to site of arterial occlusion
- The Revascularization Scales Dilemma: Is It Right to Apply the Treatment in Cerebral Ischemia Scale in Posterior Circulation Stroke?
- Early Loss of Immediate Reperfusion While Stent Retriever in Place Predicts Successful Final Reperfusion in Acute Ischemic Stroke Patients
- Endovascular revascularization results in IMS III: intracranial ICA and M1 occlusions
- Outcome Differences between Intra-Arterial Iso- and Low-Osmolality Iodinated Radiographic Contrast Media in the Interventional Management of Stroke III Trial
- M2 occlusions as targets for endovascular therapy: comprehensive analysis of diffusion/perfusion MRI, angiography, and clinical outcomes
- Outcomes of manual aspiration thrombectomy for acute ischemic stroke refractory to stent-based thrombectomy
- Endovascular treatment for M2 occlusions in the era of stentrievers: a descriptive multicenter experience
- Mechanisms of Unexplained Neurological Deterioration After Intravenous Thrombolysis
- Correlation of AOL recanalization, TIMI reperfusion and TICI reperfusion with infarct growth and clinical outcome
- Capillary Index Score in the Interventional Management of Stroke Trials I and II
- Unexplained Early Neurological Deterioration After Intravenous Thrombolysis: Incidence, Predictors, and Associated Factors
- Addition of Hyperacute MRI Aids in Patient Selection, Decreasing the Use of Endovascular Stroke Therapy
- Acute Ischemic Stroke: Time, Penumbra, and Reperfusion
- Understanding IMS III: old data shed new light on a futile trial
- Thrombus Attenuation Does Not Predict Angiographic Results of Mechanical Thrombectomy with Stent Retrievers
- Prospective, Multicenter, Single-Arm Study of Mechanical Thrombectomy Using Solitaire Flow Restoration in Acute Ischemic Stroke
- Recommendations on Angiographic Revascularization Grading Standards for Acute Ischemic Stroke: A Consensus Statement
- What Is Meant by "TICI"?
- Epistemology, Parachutes, and "Yeah, but" Interventional Stroke Trials
- Advanced modality imaging evaluation in acute ischemic stroke may lead to delayed endovascular reperfusion therapy without improvement in clinical outcomes
- Clarifying Differences Among Thrombolysis in Cerebral Infarction Scale Variants: Is the Artery Half Open or Half Closed?
- Mechanical Recanalization With Flow Restoration in Acute Ischemic Stroke: The ReFlow (Mechanical Recanalization With Flow Restoration in Acute Ischemic Stroke) Study
- Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association
- Comparison of Stent-Retriever Devices versus the Merci Retriever for Endovascular Treatment of Acute Stroke
- The Clinical and Radiographic Importance of Distinguishing Partial from Near-Complete Reperfusion Following Intra-Arterial Stroke Therapy
- Is Intra-Arterial Thrombolysis Beneficial for M2 Occlusions? Subgroup Analysis of the PROACT-II Trial
- Retrospective Multicenter Study of Solitaire FR for Revascularization in the Treatment of Acute Ischemic Stroke
- Periprocedural antithrombotic strategies in acute ischemic stroke interventional therapy
- Elderly Patients Are at Higher Risk for Poor Outcomes After Intra-Arterial Therapy
- A Comparison of 2 Stroke Devices: The New Aperio Clot-Removal Device and the Solitaire AB/FR
- Single-Center Experience of Cerebral Artery Thrombectomy Using the TREVO Device in 60 Patients With Acute Ischemic Stroke
- TICI: If You Are Not Confused, Then You Are Not Paying Attention
- Infarct Volume Is a Pivotal Biomarker After Intra-Arterial Stroke Therapy
- Comparison of the Incidence of Parenchymal Hematoma and Poor Outcome in Patients with Carotid Terminus Occlusion Treated with Intra-Arterial Urokinase Alone or with Combined IV rtPA and Intra-Arterial Urokinase
- Carotid Artery Stenting in Acute Stroke
- Rescue, Combined, and Stand-Alone Thrombectomy in the Management of Large Vessel Occlusion Stroke Using the Solitaire Device: A Prospective 50-Patient Single-Center Study: Timing, Safety, and Efficacy
- Metrics for Measuring Quality of Care in Comprehensive Stroke Centers: Detailed Follow-Up to Brain Attack Coalition Comprehensive Stroke Center Recommendations: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association
- Acute Stroke Intervention
- Endovascular Stroke Treatment Today
- Stent-Assisted Mechanical Recanalization for Treatment of Acute Intracerebral Artery Occlusions
- Indications for the performance of intracranial endovascular neurointerventional procedures. A scientific statement from the American Heart Association Council on Cardiovascular Radiology and Intervention, Stroke Council, Council on Cardiovascular Surgery and Anesthesia, Interdisciplinary Council on Peripheral Vascular Disease, and Interdisciplinary Council on Quality of Care and Outcomes Research
- Endovascular Thrombectomy for Acute Ischemic Stroke in Failed Intravenous Tissue Plasminogen Activator Versus Non-Intravenous Tissue Plasminogen Activator Patients: Revascularization and Outcomes Stratified by the Site of Arterial Occlusions
- Clinical Outcomes in Middle Cerebral Artery Trunk Occlusions Versus Secondary Division Occlusions After Mechanical Thrombectomy: Pooled Analysis of the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) and Multi MERCI Trials
- Equipoise among recanalization strategies
- Occurrence and Predictors of Futile Recanalization following Endovascular Treatment among Patients with Acute Ischemic Stroke: A Multicenter Study
- Reperfusion Is a More Accurate Predictor of Follow-Up Infarct Volume Than Recanalization: A Proof of Concept Using CT in Acute Ischemic Stroke Patients
- Predictors of Good Clinical Outcomes, Mortality, and Successful Revascularization in Patients With Acute Ischemic Stroke Undergoing Thrombectomy: Pooled Analysis of the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) and Multi MERCI Trials
- MRI-Based Selection for Intra-Arterial Stroke Therapy: Value of Pretreatment Diffusion-Weighted Imaging Lesion Volume in Selecting Patients With Acute Stroke Who Will Benefit From Early Recanalization
- Endovascular Approaches to Acute Stroke, Part 2: A Comprehensive Review of Studies and Trials
- Advances in Interventional Neuroradiology
- Indications for the Performance of Intracranial Endovascular Neurointerventional Procedures: A Scientific Statement From the American Heart Association Council on Cardiovascular Radiology and Intervention, Stroke Council, Council on Cardiovascular Surgery and Anesthesia, Interdisciplinary Council on Peripheral Vascular Disease, and Interdisciplinary Council on Quality of Care and Outcomes Research
- Ultrasound Enhancement of Fibrinolysis
- MR and CT Monitoring of Recanalization, Reperfusion, and Penumbra Salvage: Everything That Recanalizes Does Not Necessarily Reperfuse!