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Clarifying differences among thrombolysis in cerebral infarction scale variants: is the artery half open or half closed?
- Source :
-
Stroke [Stroke] 2013 Apr; Vol. 44 (4), pp. 1166-8. Date of Electronic Publication: 2013 Feb 14. - Publication Year :
- 2013
-
Abstract
- 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.<br />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.<br />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).<br />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.
- Subjects :
- Aged
Angiography methods
Female
Fibrinolytic Agents pharmacology
Humans
Male
Middle Aged
Models, Statistical
Neurology methods
Observer Variation
Perfusion
Radiology methods
Reperfusion
Reproducibility of Results
Stroke therapy
Treatment Outcome
Arteries pathology
Cerebral Infarction diagnosis
Cerebral Infarction physiopathology
Thrombolytic Therapy methods
Subjects
Details
- Language :
- English
- ISSN :
- 1524-4628
- Volume :
- 44
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Stroke
- Publication Type :
- Academic Journal
- Accession number :
- 23412375
- Full Text :
- https://doi.org/10.1161/STROKEAHA.111.000399