Systematic review and meta-analysis on outcome differences among patients with TICI2b versus TICI3 reperfusions: success revisited.

Kaesmacher, Johannes; Dobrocky, Tomas; Heldner, Mirjam Rachel; Bellwald, Sebastian; Mosimann, Pascal John; Mordasini, Pasquale; Bigi, Sandra; Arnold, Marcel; Gralla, Jan; Fischer, Urs (2018). Systematic review and meta-analysis on outcome differences among patients with TICI2b versus TICI3 reperfusions: success revisited. Journal of neurology, neurosurgery and psychiatry, 89(9), pp. 910-917. BMJ Publishing Group 10.1136/jnnp-2017-317602

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OBJECTIVE A reperfusion quality of thrombolysis in cerebral infarction (TICI)≥2b has been set as the therapeutic angiography target for interventions in patients with acute ischaemic stroke. This study addresses whether the distinction between TICI2b and TICI3 reperfusions shows a clinically relevant difference on functional outcome. METHODS A systematic literature review and meta-analysis was carried out and presented in conformity with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria to test the primary hypothesis that TICI2b and TICI3 reperfusions are associated with different rates of modified Rankin Scale (mRS) ≤2 at day 90. Secondary endpoints included rates of haemorrhagic transformations, mortality and excellent functional outcome (mRS ≤1). Summary estimates of ORs (sOR) with 95% CI were calculated using the inverse variance heterogeneity model accounting for multiple true effect sizes. RESULTS Fourteen studies on 2379 successfully reperfused patients were included (1131 TICI3, 1248 TICI2b). TICI3 reperfusions were associated with higher rates of functional independence (1.74, 95% CI 1.44 to 2.10) and excellent functional outcomes (2.01, 95% CI 1.60 to 2.53), also after including adjusted estimates. The safety profile of patients with TICI3 was superior, as demonstrated by lower rates of mortality (sOR 0.59, 95% CI 0.37 to 0.92) and symptomatic intracranial haemorrhages (sOR 0.42, 95% CI 0.25 to 0.71). CONCLUSION TICI3 reperfusions are associated with superior outcome and better safety profiles than TICI2b reperfusions. This effect seems to be independent of time and collaterals. As reperfusion quality is the most important modifiable predictor of patients' outcome, a more conservative definition of successful therapy and further evaluation of treatment approaches geared towards achieving TICI3 reperfusions are desirable.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine

UniBE Contributor:

Kaesmacher, Johannes; Dobrocky, Tomas; Heldner, Mirjam Rachel; Bellwald, Sebastian; Mosimann, Pascal John; Mordasini, Pasquale; Bigi, Sandra; Arnold, Marcel; Gralla, Jan and Fischer, Urs

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0022-3050

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Stefanie Hetzenecker

Date Deposited:

19 Apr 2018 16:22

Last Modified:

20 Aug 2018 01:31

Publisher DOI:

10.1136/jnnp-2017-317602

PubMed ID:

29519899

BORIS DOI:

10.7892/boris.112717

URI:

https://boris.unibe.ch/id/eprint/112717

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