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TICI and Age: What's the Score?
L A Slater1, J M Coutinho1, J Gralla2
1From the Division of Neuroradiology (L.A.S., J.M.C., V.M.P.), Joint Department of Medical Imaging, Department of Medical Imaging.
AJNR. American Journal of Neuroradiology
|November 28, 2015
Summary
Advanced age does not predict worse outcomes after mechanical thrombectomy. Successful reperfusion significantly benefits older patients, with the greatest magnitude of effect observed in those over 70 years old.
Area of Science:
- Neurology
- Interventional Neurology
- Stroke Medicine
Background:
- Advanced age has been associated with poorer outcomes after mechanical thrombectomy for acute ischemic stroke.
- Recent large prospective studies provide an opportunity to re-evaluate this association.
Purpose of the Study:
- To assess the relationship between TICI (Treatment in Cerebral Infarction) perfusion grades, patient age, and clinical outcomes.
- To determine if age influences the benefit of successful reperfusion in mechanical thrombectomy.
Main Methods:
- Pooled data from the STAR and SWIFT trials, including patients treated with the Solitaire device.
- TICI scores were assessed by a core laboratory; good outcome was defined as modified Rankin Scale (mRS) 0-2 at 90 days.
- Analysis of the association between outcome, reperfusion (TICI 2b-3 vs. 0-2a), and age (dichotomized at the median of 70 years).
Main Results:
- A total of 269 patients were analyzed, with a median age of 70 years.
- While younger patients had a higher absolute rate of good outcomes (64% vs. 44%), the magnitude of benefit from successful reperfusion was greater in patients aged 70 and older.
- No significant differences in baseline NIHSS or procedure times were observed between age groups.
Conclusions:
- Successful reperfusion is the primary predictor of good outcomes after mechanical thrombectomy.
- The greatest benefit from successful reperfusion is observed in patients aged 70 years and older, challenging the notion that advanced age portends worse outcomes.
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