Need for refining successful revascularization in endovascular treatment of acute ischemic stroke: Data from real-world

Abstract Introduction Modified TICI (mTICI) score ≥ 2b has been largely used as a definition of successful revascularization in acute stroke endovascular treatment (EVT). However, mTICI 2b encompasses a broad range of different revascularization states and its clinical relevance, comparing to mTICI 3, has been questioned. We aimed to compare clinical outcomes between these two reperfusion groups, in patients submitted to EVT for anterior circulation large-vessel occlusion, in a real-world setting. Materials and methods Retrospective statistical analysis of our database of consecutive EVTs. Results Our study population of 178 patients has a mean age of 71 years, 46.6% males, median baseline NIHSS of 17 and ASPECTS of 8. There were no statistically significant differences in baseline characteristics and interventional procedure data between groups. A significantly higher rate of mRS ≤ 1 at 3 months (OR = 2.33, 95%CI 1.03–5.25) and lower rate of total (OR = 0.18, 95%CI 0.06–0.53) and symptomatic intracranial hemorrhage (OR = 0.08, 95%CI 0.01–0.74) was seen in mTICI 3 group. This group also showed non-significant trend (adjusted p  = 0.071) toward higher percentages of mRS ≤ 2 (71.8% versus 51.5%) and lower mortality at 3 months (6.4% versus 19.1%). Conclusions In accordance with previous reports from clinical trials, these real-world data suggest that is probably time to refine the definition of successful revascularization in acute stroke EVT.