Refining angiographic biomarkers of revascularization: Improving outcome prediction after intra-arterial therapy

Albert J. Yoo, Claus Z. Simonsen, Shyam Prabhakaran, Zeshan A. Chaudhry, Mohammad A. Issa, Jennifer E. Fugate, Italo Linfante, David S. Liebeskind, Pooja Khatri, Tudor G. Jovin, David F Kallmes, Guilherme Dabus, Osama O. Zaidat

Research output: Contribution to journalArticle

90 Citations (Scopus)

Abstract

Background and Purpose - Angiographic revascularization grading after intra-arterial stroke therapy is limited by poor standardization, making it unclear which scale is optimal for predicting outcome. Using recently standardized criteria, we sought to compare the prognostic performance of 2 commonly used reperfusion scales. Methods - Inclusion criteria for this multicenter retrospective study were acute ischemic stroke attributable to middle cerebral artery M1 occlusion, intra-arterial therapy, and 90-day modified Rankin scale score. Post-intra-arterial therapy reperfusion was graded using the Thrombolysis in Myocardial Infarction (TIMI) and Modified Thrombolysis in Cerebral Infarction (mTICI) scales. The scales were compared for prediction of clinical outcome using receiver-operating characteristic analysis. Results - Of 308 patients, mean age was 65 years, and median National Institutes of Health Stroke Scale score was 17. The mean time from stroke onset to groin puncture was 305 minutes. There was no difference in the time to treatment between patients grouped by final TIMI (ie, 0 versus 1 versus 2 versus 3) or mTICI grades (ie, 0 versus 1 versus 2a versus 2b versus 3). Good outcome (modified Rankin scale, 0-2) was achieved in 32.5% of patients, and mortality rate was 25.3% at 90 days. There was a 6.3% rate of parenchymal hematoma type 2. In receiver-operating characteristic analysis, mTICI was superior to TIMI for predicting 90-day modified Rankin scale 0 to 2 (c-statistic: 0.74 versus 0.68; P<0.0001). The optimal threshold for identifying a good outcome was mTICI 2b to 3 (sensitivity 78.0%; specificity 66.1%). Conclusions - mTICI is superior to TIMI for predicting clinical outcome after intra-arterial therapy. mTICI 2b to 3 is the optimal biomarker for procedural success.

Original languageEnglish (US)
Pages (from-to)2509-2512
Number of pages4
JournalStroke
Volume44
Issue number9
DOIs
StatePublished - Sep 2013

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Cerebral Infarction
Biomarkers
Stroke
Myocardial Infarction
ROC Curve
Reperfusion
Therapeutics
Groin
Middle Cerebral Artery Infarction
National Institutes of Health (U.S.)
Punctures
Hematoma
Multicenter Studies
Retrospective Studies
Mortality

Keywords

  • Acute ischemic stroke
  • Endovascular
  • Intra-arterial therapy
  • Modified TICI
  • Revascularization
  • TIMI

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Yoo, A. J., Simonsen, C. Z., Prabhakaran, S., Chaudhry, Z. A., Issa, M. A., Fugate, J. E., ... Zaidat, O. O. (2013). Refining angiographic biomarkers of revascularization: Improving outcome prediction after intra-arterial therapy. Stroke, 44(9), 2509-2512. https://doi.org/10.1161/STROKEAHA.113.001990

Refining angiographic biomarkers of revascularization : Improving outcome prediction after intra-arterial therapy. / Yoo, Albert J.; Simonsen, Claus Z.; Prabhakaran, Shyam; Chaudhry, Zeshan A.; Issa, Mohammad A.; Fugate, Jennifer E.; Linfante, Italo; Liebeskind, David S.; Khatri, Pooja; Jovin, Tudor G.; Kallmes, David F; Dabus, Guilherme; Zaidat, Osama O.

In: Stroke, Vol. 44, No. 9, 09.2013, p. 2509-2512.

Research output: Contribution to journalArticle

Yoo, AJ, Simonsen, CZ, Prabhakaran, S, Chaudhry, ZA, Issa, MA, Fugate, JE, Linfante, I, Liebeskind, DS, Khatri, P, Jovin, TG, Kallmes, DF, Dabus, G & Zaidat, OO 2013, 'Refining angiographic biomarkers of revascularization: Improving outcome prediction after intra-arterial therapy', Stroke, vol. 44, no. 9, pp. 2509-2512. https://doi.org/10.1161/STROKEAHA.113.001990
Yoo, Albert J. ; Simonsen, Claus Z. ; Prabhakaran, Shyam ; Chaudhry, Zeshan A. ; Issa, Mohammad A. ; Fugate, Jennifer E. ; Linfante, Italo ; Liebeskind, David S. ; Khatri, Pooja ; Jovin, Tudor G. ; Kallmes, David F ; Dabus, Guilherme ; Zaidat, Osama O. / Refining angiographic biomarkers of revascularization : Improving outcome prediction after intra-arterial therapy. In: Stroke. 2013 ; Vol. 44, No. 9. pp. 2509-2512.
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AU - Chaudhry, Zeshan A.

AU - Issa, Mohammad A.

AU - Fugate, Jennifer E.

AU - Linfante, Italo

AU - Liebeskind, David S.

AU - Khatri, Pooja

AU - Jovin, Tudor G.

AU - Kallmes, David F

AU - Dabus, Guilherme

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N2 - Background and Purpose - Angiographic revascularization grading after intra-arterial stroke therapy is limited by poor standardization, making it unclear which scale is optimal for predicting outcome. Using recently standardized criteria, we sought to compare the prognostic performance of 2 commonly used reperfusion scales. Methods - Inclusion criteria for this multicenter retrospective study were acute ischemic stroke attributable to middle cerebral artery M1 occlusion, intra-arterial therapy, and 90-day modified Rankin scale score. Post-intra-arterial therapy reperfusion was graded using the Thrombolysis in Myocardial Infarction (TIMI) and Modified Thrombolysis in Cerebral Infarction (mTICI) scales. The scales were compared for prediction of clinical outcome using receiver-operating characteristic analysis. Results - Of 308 patients, mean age was 65 years, and median National Institutes of Health Stroke Scale score was 17. The mean time from stroke onset to groin puncture was 305 minutes. There was no difference in the time to treatment between patients grouped by final TIMI (ie, 0 versus 1 versus 2 versus 3) or mTICI grades (ie, 0 versus 1 versus 2a versus 2b versus 3). Good outcome (modified Rankin scale, 0-2) was achieved in 32.5% of patients, and mortality rate was 25.3% at 90 days. There was a 6.3% rate of parenchymal hematoma type 2. In receiver-operating characteristic analysis, mTICI was superior to TIMI for predicting 90-day modified Rankin scale 0 to 2 (c-statistic: 0.74 versus 0.68; P<0.0001). The optimal threshold for identifying a good outcome was mTICI 2b to 3 (sensitivity 78.0%; specificity 66.1%). Conclusions - mTICI is superior to TIMI for predicting clinical outcome after intra-arterial therapy. mTICI 2b to 3 is the optimal biomarker for procedural success.

AB - Background and Purpose - Angiographic revascularization grading after intra-arterial stroke therapy is limited by poor standardization, making it unclear which scale is optimal for predicting outcome. Using recently standardized criteria, we sought to compare the prognostic performance of 2 commonly used reperfusion scales. Methods - Inclusion criteria for this multicenter retrospective study were acute ischemic stroke attributable to middle cerebral artery M1 occlusion, intra-arterial therapy, and 90-day modified Rankin scale score. Post-intra-arterial therapy reperfusion was graded using the Thrombolysis in Myocardial Infarction (TIMI) and Modified Thrombolysis in Cerebral Infarction (mTICI) scales. The scales were compared for prediction of clinical outcome using receiver-operating characteristic analysis. Results - Of 308 patients, mean age was 65 years, and median National Institutes of Health Stroke Scale score was 17. The mean time from stroke onset to groin puncture was 305 minutes. There was no difference in the time to treatment between patients grouped by final TIMI (ie, 0 versus 1 versus 2 versus 3) or mTICI grades (ie, 0 versus 1 versus 2a versus 2b versus 3). Good outcome (modified Rankin scale, 0-2) was achieved in 32.5% of patients, and mortality rate was 25.3% at 90 days. There was a 6.3% rate of parenchymal hematoma type 2. In receiver-operating characteristic analysis, mTICI was superior to TIMI for predicting 90-day modified Rankin scale 0 to 2 (c-statistic: 0.74 versus 0.68; P<0.0001). The optimal threshold for identifying a good outcome was mTICI 2b to 3 (sensitivity 78.0%; specificity 66.1%). Conclusions - mTICI is superior to TIMI for predicting clinical outcome after intra-arterial therapy. mTICI 2b to 3 is the optimal biomarker for procedural success.

KW - Acute ischemic stroke

KW - Endovascular

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KW - Revascularization

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