Expanded treatment in cerebral ischemia (eTICI) score

The expanded treatment in cerebral infarction (eTICIscore was further modified from the modified treatment in cerebral infarction (mTICI) and thrombolysis in cerebral infarction (TICI) scale 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
  • grade 1: reduction in thrombus without filling of distal arterial branches
  • grade 2
    • grade 2a: reperfusion in 50–66% of the territory
    • grade 2b:  reperfusion in 67–89% of the territory
    • grade 2c: extensive reperfusion in 90–99%
  • grade 3: complete or full 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
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