Assessment of automated TICI scoring during endovascular treatment in patients with an ischemic stroke

P. Matthijs van der Sluijs*, Ruisheng Su, Sandra Cornelissen, Adriaan C. G. M. van Es, Geert J. Nijeholt, Pieter Jan van Doormaal, Wim H. van Zwam, Diederik W. J. Dippel, T. van Walsum, Aad van der Lugt, MR CLEAN Registry Investigators

*Corresponding author for this work

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Abstract

Background The extended Thrombolysis in Cerebral Infarction (eTICI) score is used in digital subtraction angiography (DSA) to quantify reperfusion grade in patients with an ischemic stroke who undergo endovascular thrombectomy (EVT). A previously developed automatic TICI score (autoTICI), which quantifies the ratio of reperfused pixels after EVT, demonstrates good correlation with eTICI.Objective To evaluate the autoTICI model in a large multicenter registry of patients with an ischemic stroke, investigate the association with visual eTICI, and compare prediction of functional outcome between autoTICI and eTICI.Methods Patients in the MR CLEAN Registry with an internal carotid artery, M1, and M2 occlusion were selected if both anteroposterior and lateral views were present in pre- and post-EVT DSA scans. The autoTICI score was compared with eTICI in predicting favorable functional outcome (modified Rankin Scale score 0-2), using area under the receiver operating characteristics curve (AUC) with a multivariable logistic regression model including known prognostic characteristics.Results In total 421 of 3637 patients were included. AutoTICI was significantly associated with eTICI non-linearly (below 70% cOR=2.3 (95% CI 2.1 to 2.5), above 70% cOR=1.6 (95% CI 1.6 to 1.7) per 10% increment). The AUC of the model predicting favorable functional outcome was similar for autoTICI and eTICI (0.86, 95% CI 0.82 to 0.92 vs 0.86, 95% CI 0.83 to 0.90, P=0.73) and was higher than for a model with prognostic patient characteristics alone (0.86 vs 0.84, P=0.01).Conclusion Automatic quantitative assessment of reperfusion after EVT is associated with eTICI, and prediction of functional outcome is similar to that with visual eTICI. Therefore, autoTICI could be used as an alternative or additional review for visual reperfusion assessment to facilitate reproducible and uniform reporting.
Original languageEnglish
Number of pages8
JournalJournal of Neurointerventional Surgery
DOIs
Publication statusE-pub ahead of print - 1 Jul 2024

Keywords

  • Thrombectomy
  • Stroke
  • Angiography
  • STANDARDS
  • OCCLUSION
  • DSA

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