2B, 2C, or 3 What Should Be the Angiographic Target for Endovascular Treatment in Ischemic Stroke?

Natalie E. LeCouffe, Manon Kappelhof, Kilian M. Treurniet, Hester F. Lingsma, Guang Zhang, Ido R. van den Wijngaard, Adriaan C. G. M. van Es, Bart J. Emmer, Charles B. L. M. Majoie, Yvo B. W. E. M. Roos, Jonathan M. Coutinho*, Wim van Zwam, Robert Jan van Oostenbrugge, MR CLEAN Registry Investigators

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Background and Purpose-

A score of >= 2B on the modified Thrombolysis in Cerebral Infarction scale is generally regarded as successful reperfusion after endovascular treatment for ischemic stroke. The extended Thrombolysis in Cerebral Infarction (eTICI) includes a 2C grade, which indicates near-perfect reperfusion. We investigated how well the respective eTICI scores of 2B, 2C, and 3 correlate with clinical outcome after endovascular treatment.


We used data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry, a prospective, nationwide registry of endovascular treatment in the Netherlands. We included patients with a proximal intracranial occlusion of the anterior circulation for whom final antero-posterior and lateral digital subtraction angiography imaging was available. Our primary outcome was the distribution on the modified Rankin Scale at 90 days per eTICI grade. We performed (ordinal) logistic regression analyses, using eTICI 2B as reference group, and adjusted for potential confounders.


In total, 2807/3637 (77%) patients met the inclusion criteria. Of these, 17% achieved reperfusion grade eTICI 0 to 1, 14% eTICI 2A, 25% eTICI 2B, 12% eTICI 2C, and 32% eTICI 3. Groups differed in terms of age (P


Our results indicate a continuous relationship between reperfusion grade and functional outcome, with eTICI 3 leading to the best outcomes. Although this implies that interventionists should aim for the highest possible reperfusion grade, further research on the optimal strategy is necessary.

Original languageEnglish
Pages (from-to)1790-1796
Number of pages7
Issue number6
Publication statusPublished - Jun 2020


  • cerebral infarction
  • digital subtraction angiography
  • goals
  • reperfusion
  • thrombectomy
  • CARE


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