TY - JOUR
T1 - Clarifying differences among thrombolysis in cerebral infarction scale variants
T2 - Is the artery half open or half closed?
AU - Suh, Sang Hyun
AU - Cloft, Harry J.
AU - Fugate, Jennifer E.
AU - Rabinstein, Alejandro A.
AU - Liebeskind, David S.
AU - Kallmes, David F.
N1 - Copyright:
Copyright 2013 Elsevier B.V., All rights reserved.
PY - 2013/4
Y1 - 2013/4
N2 - 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. 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. 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). 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.
AB - 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. 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. 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). 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.
KW - Interobserver variability
KW - Reperfusion
KW - Stroke
KW - TICI
KW - Thrombolytic therapy
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U2 - 10.1161/STROKEAHA.111.000399
DO - 10.1161/STROKEAHA.111.000399
M3 - Article
C2 - 23412375
AN - SCOPUS:84876281241
VL - 44
SP - 1166
EP - 1168
JO - Stroke
JF - Stroke
SN - 0039-2499
IS - 4
ER -