• Varun Naragum, Gaurav Jindal, Timothy Miller, Matthew Kole, Ravishankar Shivashankar, Jose G Merino, John Cole, Rong Chen, Nathan Kohler, and Dheeraj Gandhi.
• Division of Interventional Neuroradiology, Department of Radiology, University of Maryland Medical Center, Baltimore, Maryland, USA.
• World Neurosurg. 2018 Nov 1; 119: e928-e933.

BackgroundWithin the Thrombolysis In Cerebral Infarction (TICI) classification, TICI 2b has been historically considered successful recanalization. However, TICI 2b may result in worse functional outcomes compared with TICI 3 or a proposed TICI 2c revascularization grade. The aim of this study was to evaluate differences in functional independence at 90 days between TICI 2b, 2c, and 3 grades.MethodsA retrospective review of 185 consecutive patients with anterior cerebral circulation occlusions was performed; 33 patients who were treated >8 hours after onset were excluded. Patient angiograms were graded by 2 experienced neurointerventional physicians. Baseline demographics and functional independence at 90 days were compared.ResultsOf 152 patients included in the study, 113 patients achieved TICI grade 2b (n = 37), 2c (n = 34), or 3 (n = 42). A significant difference in functional independence at 90 days was observed between TICI 2b and 2c/3 (P = 0.0008), between 2b and 2c (P = 0.0005), and between 2b and 3 (P = 0.01). There was no significant difference in functional independence between 2c and 3 (P = 0.24).ConclusionsTICI 2c revascularization is associated with significantly improved outcomes compared with TICI 2b revascularization and similar outcomes compared with TICI 3 revascularization. Using a TICI grading system that includes an additional TICI 2c grade or expands the current definition of TICI 3 allows for refined prediction of functional independence. Achieving TICI 2c/3 reperfusion should be considered during stroke thrombectomy.Copyright © 2018 Elsevier Inc. All rights reserved.

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