Comparison of newly introduced cerebral angiographic revascularization grading eTICI with the actual standard mTICI scale
von Ruben Colla
Datum der mündl. Prüfung:2020-03-25
Betreuer:PD Dr. Marios-Nikos Psychogios
Gutachter:PD Dr. Jan Liman
Gutachter:Prof. Dr. Margarete Schön
EnglischStroke represents a common pathology with potentially heavily debilitating or lethal consequences if untreated. The last two decades witnessed a remarkable development of therapeutic options for ischemic stroke, the most frequent subtype of cerebrovascular accident. Current therapeutic options include both medical treatment and minimally invasive mechanical thrombectomy. The progress in techniques and methods led to remarkable improvement of outcome in stroke patients. Parallel to the evolution of interventional stroke treatment, there has been a development in revascularization grading, utilized to assess the success of mechanical embolectomy of large vessel occlusion. Several gradings are available and the most commonly adopted is the “modified treatment in cerebral ischemia” (mTICI). Although the mTICI scale represents a practical and relatively simple scale easily applied in everyday clinical practice, it shows a considerable lack of predictability of clinical outcome in middle to high percentages of revascularization of ischemic territory. In order to overcome this limitation we investigate a new angiographic revascularization grading, named “expanded treatment in cerebral ischemia” (eTICI), and we compare the ability of the newly introduced eTICI to the mTICI angiographic revascularization grading in predicting the clinical neurological outcome and functional independence after endovascular treatment of large vessel occlusion in a real world cohort. Moreover we examine the influence of time on the angiographic outcome (eTICI) after endovascular treatment. This study demonstrates the utility of the novel eTICI score, which expands the previous mTICI scale, showing that the eTICI score allows an overall better neurological outcome prediction compared to mTICI. Thereby granulation of the mTICI2b category into three more precise subdivisions (eTICI2b50, 2b67 and 2c) grants a more refined prediction of neurological outcome after thrombectomy of a large vessel occlusion compared to mTICI2b alone. This analysis also confirms the critical role of time in interventional stroke therapy and may provide a helpful tool in the management of patients with initial unfavorable angiographic score. Moreover, higher degrees of recanalization of large vessel occlusion treated with mechanical thrombectomy result in greater neurological improvement and functional independence. Further multicentric trials may be necessary to investigate outcome prediction of the eTICI score on a larger cohort of patients as well as deepen our understanding of the role of time in interventional stroke treatment.
Keywords: Stroke; mTICI; eTICI; Endovascular treatment; Mechanical thrombectomy; Angiographic revascularization grading