TY - JOUR
T1 - qTICI
T2 - Quantitative assessment of brain tissue reperfusion on digital subtraction angiograms of acute ischemic stroke patients
AU - Prasetya, Haryadi
AU - Ramos, Lucas A.
AU - Epema, Thabiso
AU - Treurniet, Kilian M.
AU - Emmer, Bart J.
AU - van den Wijngaard, Ido R.
AU - Zhang, Guang
AU - Kappelhof, Manon
AU - Berkhemer, Olvert A.
AU - Yoo, Albert J.
AU - Roos, Yvo B. E. W. M.
AU - van Oostenbrugge, Robert J.
AU - Dippel, Diederik W. J.
AU - van Zwam, Wim H.
AU - van der Lugt, Aad
AU - de Mol, Bas A. J. M.
AU - Majoie, Charles B. L. M.
AU - Bavel, Ed van
AU - Marquering, Henk A.
AU - MR CLEAN Registry Investigators
N1 - Funding Information:
qTICI provides a quantitative measure of reperfusion with similar prognostic value for functional outcome to eTICI score. Digital subtraction angiography reperfusion ischemic stroke endovascular therapy Indonesia Endowment Fund for Education (LPDP), Ministry of Finance, Republic of Indonesia LPDP scholarship Program for Doctorate Students edited-state corrected-proof typesetter ts2
Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by Indonesia Endowment Fund for Education (LPDP), Ministry of Finance, Republic of Indonesia.
Publisher Copyright:
© 2020 World Stroke Organization.
PY - 2021/2
Y1 - 2021/2
N2 - BackgroundThe Thrombolysis in Cerebral Infarction (TICI) scale is an important outcome measure to evaluate the quality of endovascular stroke therapy. The TICI scale is ordinal and observer-dependent, which may result in suboptimal prediction of patient outcome and inconsistent reperfusion grading.AimsWe present a semi-automated quantitative reperfusion measure (quantified TICI (qTICI)) using image processing techniques based on the TICI methodology.MethodsWe included patients with an intracranial proximal large vessel occlusion with complete, good quality runs of anteroposterior and lateral digital subtraction angiography from the MR CLEAN Registry. For each vessel occlusion, we identified the target downstream territory and automatically segmented the reperfused area in the target downstream territory on final digital subtraction angiography. qTICI was defined as the percentage of reperfused area in target downstream territory. The value of qTICI and extended TICI (eTICI) in predicting favorable functional outcome (modified Rankin Scale 0-2) was compared using area under receiver operating characteristics curve and binary logistic regression analysis unadjusted and adjusted for known prognostic factors.ResultsIn total, 408 patients with M1 or internal carotid artery occlusion were included. The median qTICI was 78 (interquartile range 58-88) and 215 patients (53%) had an eTICI of 2C or higher. qTICI was comparable to eTICI in predicting favorable outcome with area under receiver operating characteristics curve of 0.63 vs. 0.62 (P = 0.8) and 0.87 vs. 0.86 (P = 0.87), for the unadjusted and adjusted analysis, respectively. In the adjusted regression analyses, both qTICI and eTICI were independently associated with functional outcome.ConclusionqTICI provides a quantitative measure of reperfusion with similar prognostic value for functional outcome to eTICI score.
AB - BackgroundThe Thrombolysis in Cerebral Infarction (TICI) scale is an important outcome measure to evaluate the quality of endovascular stroke therapy. The TICI scale is ordinal and observer-dependent, which may result in suboptimal prediction of patient outcome and inconsistent reperfusion grading.AimsWe present a semi-automated quantitative reperfusion measure (quantified TICI (qTICI)) using image processing techniques based on the TICI methodology.MethodsWe included patients with an intracranial proximal large vessel occlusion with complete, good quality runs of anteroposterior and lateral digital subtraction angiography from the MR CLEAN Registry. For each vessel occlusion, we identified the target downstream territory and automatically segmented the reperfused area in the target downstream territory on final digital subtraction angiography. qTICI was defined as the percentage of reperfused area in target downstream territory. The value of qTICI and extended TICI (eTICI) in predicting favorable functional outcome (modified Rankin Scale 0-2) was compared using area under receiver operating characteristics curve and binary logistic regression analysis unadjusted and adjusted for known prognostic factors.ResultsIn total, 408 patients with M1 or internal carotid artery occlusion were included. The median qTICI was 78 (interquartile range 58-88) and 215 patients (53%) had an eTICI of 2C or higher. qTICI was comparable to eTICI in predicting favorable outcome with area under receiver operating characteristics curve of 0.63 vs. 0.62 (P = 0.8) and 0.87 vs. 0.86 (P = 0.87), for the unadjusted and adjusted analysis, respectively. In the adjusted regression analyses, both qTICI and eTICI were independently associated with functional outcome.ConclusionqTICI provides a quantitative measure of reperfusion with similar prognostic value for functional outcome to eTICI score.
KW - Digital subtraction angiography
KW - reperfusion
KW - ischemic stroke
KW - endovascular therapy
KW - INTERVENTIONAL MANAGEMENT
KW - ENDOVASCULAR TREATMENT
KW - REVASCULARIZATION
KW - THROMBOLYSIS
KW - RECANALIZATION
KW - TRIAL
KW - THROMBECTOMY
KW - STANDARDS
KW - SCALE
KW - TIME
U2 - 10.1177/1747493020909632
DO - 10.1177/1747493020909632
M3 - Article
C2 - 32098584
SN - 1747-4930
VL - 16
SP - 207
EP - 216
JO - International journal of stroke
JF - International journal of stroke
IS - 2
ER -