Expanded treatment in cerebral ischemia (eTICI) score

The expanded treatment in cerebral infarction (eTICI) score is a modified from the modified treatment in cerebral infarction (mTICI) and thrombolysis in cerebral infarction (TICI) scales. It was published by the HERMES investigators in 2019¹.

Using modified Rankin scale (mRs) shift at 90 days as the outcome measure, the investigators found a significant difference in outcomes for patients with partial recanalization after mechanical thrombectomy between those with reperfusion of 50–66%, 67–89% and 90-90% in addition to those previously defined by mTICI.

Classification

• grade 0: no perfusion noted (0% reperfusion)
• grade 1: reduction in thrombus but without any resultant filling of distal arterial branches
• grade 2
  • grade 2a: reperfusion of 1-49% of the territory
  • grade 2b50: reperfusion of 50–66% of the territory
  • grade 2b67: reperfusion of 67–89% of the territory
  • grade 2c: extensive reperfusion of 90–99% of the territory
• grade 3: complete or full reperfusion (100% reperfusion)

Important points

• Inter-rater agreement is the most difficult between eTICI grade 2a and 2b, however with adequate angiographic views agreement of 92% (κ=0.83, p<0.001) was reported by the investigators¹
• eTICI appears to be an independent predictor of 90-day mRS