Abstract TMP3: Revascularization Endpoints in SWIFT
Background and Purpose — The acute stroke literature contains numerous definitions of the critical end point of revascularization. We sought to determine relationship of AOL, TIMI and TICI recanalization scores with clinical outomces in the SWIFT randomized controlled trial of mechanical thrombectomy in ischemic stroke.
Methods — One hundred and thirty-three angiograms evaluated for recanalization by the SWIFT core lab were available for analysis. AOL, TIMI and TICI scores were compared with one another and with 90-day functionally independent outcome (defined as modified Rankin Score (mRS) zero to 2) and good neurological outcome (GNO) (defined as mRS zero to 2 or equal to baseline mRS if baseline mRS greater than 2, or improvement of at least 10 points in NIHSS score).
Results — Measured after use of randomized device but prior to any rescue therapy, AOL and TIMI scores showed moderate agreement (Spearman nonparametric correlation r=0.68 [confidence interval 0.59, 0.78]), while AOL and TICI were strongly correlated (r=0.76 [0.67, 0.84]) and TIMI and TICI even more so (r=0.88 [0.81, 0.94]). Using measurements after the end of the procedure, including any rescue therapy, functionally independent outcome was seen in 42.1% (45/107) of patients with AOL II/III scores (p<0.001), 50.0% (35/70) with TIMI 2/3 scores (p<0.001) and 44.9% (40/89) with TICI 2b/3 scores (p<0.001). GNO was seen in 57.0% (61/107) of patients with AOL II/III scores (p=0.003), 62.9% (44/70) with TIMI 2/3 scores (p=0.004) and 61.8% (55/89) with TICI 2b/3 scores (p<0.001). Based on receiver operating characteristic analysis, the three methods did not significantly differ from one another in predicting functionally independent outcome (AOL-TIMI p=0.11, TICI-TIMI p=0.28, AOL-TICI p=0.40) or GNO (AOL-TIMI p=0.31, TICI-TIMI p=0.76, AOL-TICI p=0.095).
Conclusions — Measures of arterial patency (AOL) and reperfusion (TICI and TIMI) scores are moderately to strongly correlated and comparably predict neurologic outcome post embolectomy procedure for acute ischemic stroke.
- © 2012 by American Heart Association, Inc.