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qTICI: Quantitative assessment of brain tissue reperfusion on digital subtraction angiograms of acute ischemic stroke patients

Posted on 2020-02-27 - 13:08
Background

The Thrombolysis in Cerebral Infarction (TICI) scale is an important outcome measure to evaluate the quality of endovascular stroke therapy. The TICI scale is ordinal and observer-dependent, which may result in suboptimal prediction of patient outcome and inconsistent reperfusion grading.

Aims

We present a semi-automated quantitative reperfusion measure (quantified TICI (qTICI)) using image processing techniques based on the TICI methodology.

Methods

We included patients with an intracranial proximal large vessel occlusion with complete, good quality runs of anteroposterior and lateral digital subtraction angiography from the MR CLEAN Registry. For each vessel occlusion, we identified the target downstream territory and automatically segmented the reperfused area in the target downstream territory on final digital subtraction angiography. qTICI was defined as the percentage of reperfused area in target downstream territory. The value of qTICI and extended TICI (eTICI) in predicting favorable functional outcome (modified Rankin Scale 0–2) was compared using area under receiver operating characteristics curve and binary logistic regression analysis unadjusted and adjusted for known prognostic factors.

Results

In total, 408 patients with M1 or internal carotid artery occlusion were included. The median qTICI was 78 (interquartile range 58–88) and 215 patients (53%) had an eTICI of 2C or higher. qTICI was comparable to eTICI in predicting favorable outcome with area under receiver operating characteristics curve of 0.63 vs. 0.62 (P = 0.8) and 0.87 vs. 0.86 (P = 0.87), for the unadjusted and adjusted analysis, respectively. In the adjusted regression analyses, both qTICI and eTICI were independently associated with functional outcome.

Conclusion

qTICI provides a quantitative measure of reperfusion with similar prognostic value for functional outcome to eTICI score.

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International Journal of Stroke

AUTHORS (19)

Haryadi Prasetya
Lucas A Ramos
Thabiso Epema
Kilian M Treurniet
Bart J Emmer
Ido R van den Wijngaard
Guang Zhang
Manon Kappelhof
Olvert A Berkhemer
Albert J Yoo
Yvo BEWM Roos
Robert J van Oostenbrugge
Diederik WJ Dippel
Wim H van Zwam
Aad van der Lugt
Bas AJM de Mol
Charles BLM Majoie
Ed van Bavel
Henk A Marquering
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