Impact of Time on Thrombolysis in Cerebral Infarction Score Results

Abstract

Purpose Extended thrombolysis in cerebral infarction (eTICI) score results of 2b or higher are known to be predictors for favorable outcome after acute stroke. Additionally, time is a\xa0major factor influencing outcome after ischemic stroke. Until today only little is known about the impact of time on angiographic results regarding the outcome after mechanical thrombectomy; however, this impact might be of interest if an initially unfavorable angiographic result has to be improved. Methods Retrospective study of 164 patients with large vessel occlusion of the anterior circulation treated by mechanical thrombectomy. Multiple logistic regression analysis of relevant periprocedural and procedural times in respect to the probability of achieving functional independence at 90\xa0days in respect to different eTICI results was performed to build a\xa0time and TICI score-dependent model for outcome prediction in which the influence of time was assumed to be steady among the TICI grades. Results The probability of achieving a\xa0favorable outcome is significantly different between eTICI2b-50, 67, TICI2c and TICI3 results ( p \u202f<\u20090.001). The odds for achieving a\xa0favorable outcome decrease over time and differ for each TICI category and time point. The individual odds for each patient, time point and TICI grade can be calculated based on this model. Conclusion The impact of periprocedural and procedural times and eTICI reperfusion results adds a\xa0new dimension to the decision-making process in patients with primary unfavorable angiographic results.