ETICI reperfusion: Defining success in endovascular stroke therapy

David S. Liebeskind, Serge Bracard, Francis Guillemin, Reza Jahan, Tudor G. Jovin, Charles B.L.M. Majoie, Peter J. Mitchell, Aad Van Der Lugt, Bijoy K. Menon, Luis San Román, Bruce C.V. Campbell, Keith W. Muir, Michael D. Hill, Diederik W.J. Dippel, Jeffrey L. Saver, Andrew M. Demchuk, Antoni Dávalos, Philip White, Scott Brown, Mayank Goyal

Research output: Contribution to journalArticleResearch

70 Citations (Scopus)


© 2019 Author(s) (or their employer(s)). No commercial re-use. See rights and permissions. Published by BMJ. Background Revascularization after endovascular therapy for acute ischemic stroke is measured by the Thrombolysis In Cerebral Infarction (TICI) scale, yet variability exists in scale definitions. We examined the degree of reperfusion with the expanded TICI (eTICI) scale and association with outcomes in the HERMES collaboration of recent endovascular trials. Methods The HERMES Imaging Core, blind to all other data, evaluated angiography after endovascular therapy in HERMES. A battery of TICI scores (mTICI, TICI, TICI2C) was used to define reperfusion of the initial target occlusion defined by non-invasive imaging and conventional angiography. Results Angiography of 801 subjects was available, including 797 defined by non-invasive imaging (154 internal carotid artery (ICA), 583 M1, 60 M2) and 748 by conventional angiography (195 ICA, 459 M1, 94 M2). Among 729 subjects in whom the reperfusion grade could be established, using eTICI (3=100%, 2C=90-99%, 2b67=67-89%, 2b50=50-66%) of the conventional angiography target occlusion, there were 63 eTICI 3 (9%), 166 eTICI 2c (23%), 218 eTICI 2b67 (30%), 103 eTICI 2b50 (14%), 100 eTICI 2a (14%), 19 eTICI 1 (3%), and 60 eTICI 0 (8%). Modified Rankin Scale shift analyses from baseline to 90 days showed that increasing TICI grades were linked with better outcomes, with significant distinctions between TICI 0/1 versus 2a (p=0.028), 2a versus 2b50 (p=0.017), and 2b50 versus 2b67 (p=0.014). Conclusions The benefit of endovascular therapy in HERMES was strongly associated with increasing degrees of reperfusion defined by eTICI. The eTICI metric identified meaningful distinctions in clinical outcomes and may be used in future studies and routine practice.
Original languageEnglish
Pages (from-to)433-438
Number of pages6
JournalJournal of NeuroInterventional Surgery
Issue number5
Publication statusPublished - 1 May 2019


  • angiography
  • stroke
  • Carotid Artery, Internal/diagnostic imaging
  • Humans
  • Middle Aged
  • Stroke/diagnostic imaging
  • Male
  • Treatment Outcome
  • Thrombolytic Therapy/methods
  • Endovascular Procedures/methods
  • Cerebral Revascularization/methods
  • Reperfusion
  • Cerebral Angiography
  • Tissue Plasminogen Activator/administration & dosage
  • Fibrinolytic Agents/administration & dosage
  • Middle Cerebral Artery/diagnostic imaging
  • Female
  • Aged
  • 2B
  • TICI 3


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