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Research ArticleNeurointervention

TICI and Age: What's the Score?

L.A. Slater, J.M. Coutinho, J. Gralla, R.G. Nogueira, A. Bonafé, A. Dávalos, R. Jahan, E. Levy, B.J. Baxter, J.L. Saver and V.M. Pereira for the STAR and SWIFT investigators
American Journal of Neuroradiology May 2016, 37 (5) 838-843; DOI: https://doi.org/10.3174/ajnr.A4618
L.A. Slater
aFrom the Division of Neuroradiology (L.A.S., J.M.C., V.M.P.), Joint Department of Medical Imaging, Department of Medical Imaging
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  • ORCID record for L.A. Slater
J.M. Coutinho
aFrom the Division of Neuroradiology (L.A.S., J.M.C., V.M.P.), Joint Department of Medical Imaging, Department of Medical Imaging
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J. Gralla
cService of Neuroradiology (J.G.), Inselspital, University of Bern, Bern, Switzerland
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R.G. Nogueira
dMarcus Stroke and Neuroscience Center (R.G.N.), Department of Neurology, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia
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A. Bonafé
eDepartment of Neuroradiology (A.B.), Hôpital Gui-de-Chauliac, Montpellier, France
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A. Dávalos
fDepartment of Neurosciences (A.D.), Hospital Universitario Germans Trias i Pujol, Barcelona, Spain
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R. Jahan
gDivision of Interventional Neuroradiology (R.J.)
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E. Levy
iToshiba Stroke and Vascular Research Center (E.L.), State University of New York at Buffalo, Buffalo, New York
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B.J. Baxter
jDepartment of Radiology (B.J.B.), Erlanger Hospital at the University of Tennessee, Chattanooga, Tennessee.
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J.L. Saver
hDepartment of Neurology and Comprehensive Stroke Center (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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V.M. Pereira
aFrom the Division of Neuroradiology (L.A.S., J.M.C., V.M.P.), Joint Department of Medical Imaging, Department of Medical Imaging
bDivision of Neurosurgery (V.M.P.), Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Article Figures & Data

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    Table 1:

    Demographics and baseline characteristics

    Characteristic70 Years or YoungerOlder Than 70 YearsP Value
    No.135134
    Male49% (66/135)34% (45/134).013
    NIHSS (median) (IQR)18 (14–20)17 (13–20).359
    Prestroke mRS (categoric)<.001
        081% (95/118)63% (71/113)
        115% (18/118)17% (19/113)
        23% (3/118)19% (21/113)
        32% (2/118)2% (2/113)
    Occluded vessel.101
        ICA21% (28/130)7% (22/132)
        M170% (91/130)64% (84/132)
        M28% (10/130)18% (24/132)
        M31% (1/130)2% (2/132)
    Baseline ASPECTS (mean)8.1 ± 1.9 (133)8.4 ± 1.4 (133).207
    IV-tPA63% (77/123)58% (70/121).513
    Baseline serum glucose level (mean)127 ± 56 (130)126 ± 56 (129).865
    Atrial fibrillation27% (36/135)51% (68/134)<.001
    Hypertension53% (72/135)74% (99/134)<.001
    Coronary artery disease21% (29/135)25% (34/134).474
    Diabetes19% (25/135)19% (25/134)1
    Hyperlipidemia46% (62/135)39% (52/134).267
    Peripheral artery disease1% (2/135)0% (0/134).498
    Smoking24% (32/135)4% (5/134)<.001
    Prior stroke or TIA13% (17/135)25% (34/134).008
    • Note:—IQR indicates interquartile range.

    • View popup
    Table 2:

    Details of endovascular procedurea

    70 Years or YoungerOlder Than 70 YearsP Value
    No. of Solitaire passes (mean)1.8 ± 1.01.7 ± 1.0.420
    Time from symptom onset to hospital arrival178 (98–265)172 (68–245).263
    Time from groin puncture to balloon guiding catheter11 (6–17)12 (8–17).12
    Time from symptom onset to groin puncture253 (205–322)255 (185–323).714
    Time from groin puncture to reperfusion46 (28–68)42 (32–70).714
    TICI 2b–387% (117/135)83% (111/134).400
    General anesthesia67% (90/135)65% (87/134).763
    Conscious sedation29% (39/135)28% (38/134).763
    • Note:—IQR indicates interquartile range.

    • ↵a All times are given as median minutes with IQR in parentheses.

    • View popup
    Table 3:

    Complications and outcome stratified by age

    70 Years or YoungerOlder Than 70 YearsP Value
    Complication
        Symptomatic intracerebral hemorrhage4% (5/135)1% (2/134).447
        PH-1 intracerebral hemorrhage2% (3/135)1% (2/134)1
        PH-2 intracerebral hemorrhage2% (3/135)0% (0/134).247
        SAH intracerebral hemorrhage1% (2/135)2% (3/134).684
        IVH intracerebral hemorrhage0% (0/135)1% (1/134).498
        Any intracerebral hemorrhage19% (25/135)14% (19/134).410
        Vasospasm27% (36/135)17% (23/134).077
        Device-related AE16% (21/135)14% (19/134).864
    Outcome at 90 days
        All-cause mortality8% (11/135)12% (16/134).318
        mRS 0–264% (87/135)12% (59/134)0.318
    • Note:—PH-1 indicates parenchymal hematoma type 1; PH-2, parenchymal hematoma type 2; IVH, intraventricular hemorrhage; AE, adverse events.

    • View popup
    Table 4:

    Rate of good outcome according to age and TICI scorea

    Age Groups (yr)TICI 2b–3TICI 0–2aUnadjusted OR (95% CI)Adjusted OR (95% CI)
    70 or younger67.5% (79/117)44.4% (8/18)2.6 (0.95–7.11)4.82 (1.32–17.63)
    Older than 7049.5% (55/111)17.4% (4/23)4.66 (1.49–14.59)7.32 (1.73–30.99)
    • ↵a The frequency of good clinical outcome is given according to age and TICI scores. For each age group, the OR is provided for good outcome in patients with successful reperfusion (TICI 2b–3) vs unsuccessful reperfusion (TICI 0–2a).

    • View popup
    Table 5:

    Rates of good outcome according to age quartiles and TICI score

    Age (yr)TICI 0–2aTICI 2b–3P Value
    60 or younger75.0% (9/12)87.0% (47/54).372
    61–7050.0% (3/6)73.0% (46/63).346
    71–7746.7% (7/15)74.1% (43/58).061
    78 or older25.0% (2/8)67.9% (36/53).044
    • View popup
    Table 6:

    Predictors of good outcome following mechanical thrombectomy in younger and older patients

    Variable70 Years or YoungerOlder Than 70 Years
    OR95% CIP ValueOR95% CIP Value
    Afib0.53(0.18–1.61).2651.5(0.58–3.90).407
    Baseline ASPECTS1.16(0.91–1.49).2221.06(0.73–1.54).752
    Baseline NIHSS0.88(0.78–0.99).0330.86(0.78–0.96).006
    Female1.28(0.49–3.33).6171.07(0.39–2.97).898
    HTN0.57(0.20–1.63).2961(0.34–2.95).995
    ICA4.01(0.88–18.33).0730.35(0.08–1.44).145
    IV-tPA1.06(0.38–2.96).9152.32(0.89–6.06).086
    Prestroke mRS score0.53(0.26–1.11).0920.64(0.38–1.10).104
    TICI 2b–34.82(1.32–17.63).0187.32(1.73–30.99).007
    • Note:—Afib indicates atrial fibrillation; HTN, hypertension.

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American Journal of Neuroradiology: 37 (5)
American Journal of Neuroradiology
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L.A. Slater, J.M. Coutinho, J. Gralla, R.G. Nogueira, A. Bonafé, A. Dávalos, R. Jahan, E. Levy, B.J. Baxter, J.L. Saver, V.M. Pereira
TICI and Age: What's the Score?
American Journal of Neuroradiology May 2016, 37 (5) 838-843; DOI: 10.3174/ajnr.A4618

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TICI and Age: What's the Score?
L.A. Slater, J.M. Coutinho, J. Gralla, R.G. Nogueira, A. Bonafé, A. Dávalos, R. Jahan, E. Levy, B.J. Baxter, J.L. Saver, V.M. Pereira
American Journal of Neuroradiology May 2016, 37 (5) 838-843; DOI: 10.3174/ajnr.A4618
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