Thrombolysis in cerebral infarction (TICI) scale [Neurosurgery Wiki]

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====== Thrombolysis in cerebral infarction (TICI) scale ======

The [[thrombolysis]] in [[cerebral infarction]] (TICI) grading system was described in [[2003]] by Higashida et al. 
((Higashida RT, Furlan AJ, Roberts H et-al. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke. 2003;34 (8): e109-37. doi:10.1161/01.STR.0000082721.62796.09)) 
as a tool for determining the response of [[thrombolytic therapy]] for [[ischemic stroke]]. In neuro-interventional radiology it is commonly used for patients post endovascular revascularization. Like most therapy response grading systems, it predicts prognosis.

===== Classification =====

The original description 
((Higashida RT, Furlan AJ, Roberts H et-al. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke. 2003;34 (8): e109-37. doi:10.1161/01.STR.0000082721.62796.09)) 
was based on the angiographic appearances of the treated occluded vessel and the distal branches:

Grade 0: no perfusion

Grade 1: penetration with minimal perfusion

Grade 2: partial perfusion

Grade 2A: only partial filling (less than two-thirds) of the entire vascular territory is visualized

Grade 2B: complete filling of all of the expected vascular territory is visualized but the filling is slower than normal

Grade 3: complete perfusion

In 2013 Fugate et al. reported marked variability in its definitions and application 
((Fugate JE, Klunder AM, Kallmes DF. What is meant by "TICI"?. AJNR Am J Neuroradiol. 2013;34 (9): 1792-7. doi:10.3174/ajnr.A3496))
((Zaidat OO, Yoo AJ, Khatri P et-al. Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement. Stroke. 2013;44 (9): 2650-63. doi:10.1161/STROKEAHA.113.001972)) 

A consensus paper from three collaborative groups published in Stroke in 2013 
((Zaidat OO, Yoo AJ, Khatri P et-al. Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement. Stroke. 2013;44 (9): 2650-63. doi:10.1161/STROKEAHA.113.001972)) 
recommended a modified scale, and a change of name from Thrombolysis in Cerebral Infarction to modified Treatment in Cerebral Infarction (mTICI), to better reflect the increased use of endovascular therapies.

===== References =====