Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement

Osama O Zaidat, Albert J Yoo, Pooja Khatri, Thomas A Tomsick, Rüdiger von Kummer, Jeffrey L Saver, Michael P Marks, Shyam Prabhakaran, David F Kallmes, Brian-Fred M Fitzsimmons, J Mocco, Joanna M Wardlaw, Stanley L Barnwell, Tudor G Jovin, Italo Linfante, Adnan H Siddiqui, Michael J Alexander, Joshua A Hirsch, Max Wintermark, Gregory Albers, Henry H Woo, Donald V Heck, Michael Lev, Richard Aviv, Werner Hacke, Steven Warach, Joseph Broderick, Colin P Derdeyn, Anthony Furlan, Raul G Nogueira, Dileep R Yavagal, Mayank Goyal, Andrew M Demchuk, Martin Bendszus, David S Liebeskind, Cerebral Angiographic Revascularization Grading (CARG) Collaborators, STIR Revascularization working group, STIR Thrombolysis in Cerebral Infarction (TICI) Task Force, Osama O Zaidat, Albert J Yoo, Pooja Khatri, Thomas A Tomsick, Rüdiger von Kummer, Jeffrey L Saver, Michael P Marks, Shyam Prabhakaran, David F Kallmes, Brian-Fred M Fitzsimmons, J Mocco, Joanna M Wardlaw, Stanley L Barnwell, Tudor G Jovin, Italo Linfante, Adnan H Siddiqui, Michael J Alexander, Joshua A Hirsch, Max Wintermark, Gregory Albers, Henry H Woo, Donald V Heck, Michael Lev, Richard Aviv, Werner Hacke, Steven Warach, Joseph Broderick, Colin P Derdeyn, Anthony Furlan, Raul G Nogueira, Dileep R Yavagal, Mayank Goyal, Andrew M Demchuk, Martin Bendszus, David S Liebeskind, Cerebral Angiographic Revascularization Grading (CARG) Collaborators, STIR Revascularization working group, STIR Thrombolysis in Cerebral Infarction (TICI) Task Force

No abstract available

Keywords: AOL; IA therapy; TICI; TIMI; embolectomy; endovascular therapy; grading; recanalization; revascularization; score; scoring; stent-retrievers; stroke; thrombectomy.

Figures

Figure 1

Example of thrombolysis in cerebral infarction (TICI) 0 and TICI 2b. Top, Anteroposterior (first 2 boxes) and lateral (last 2 boxes) in an early arterial and late capillary phases depicting TICI 0 at baseline. Bottom, Same phases depicting TICI 2b after intra-arterial therapy. Black arrow indicating the target arterial lesion (TAL): middle cerebral artery/M1 horizontal segment occlusion (TAL) distal to the lenticulostriate (LS). Black half circles approximate the target downstream territory (TDT; the presumed area supplied by the TAL).

Figure 2

Example of thrombolysis in cerebral infarction (TICI) 1 and TICI 3. Top, Anteroposterior (left) and lateral (right) in an early arterial and late capillary phases depicting TICI 1 at baseline. Bottom, Same phases depicting TICI 3 after intraarterial therapy. Black arrow indicating the target arterial lesion (TAL): middle cerebral artery/M1 horizontal segment occlusion (TAL) distal to the lenticulostriate (LS). Black half circles approximate the target downstream territory (TDT; the presumed area supplied by the TAL). Ischemic arteriovenous shunting is noted with opacification of straight sinus (right bottom corner).

Figure 3

Example of thrombolysis in cerebral infarction (TICI) 0 and TICI 2a (compared with TICI 2b and 3 above). Top, Anteroposterior (first 2 boxes) and lateral (last 2 boxes) in an early arterial and late capillary phases depicting TICI 0 at baseline. Bottom, Same phases depicting TICI 2a after intra-arterial therapy. Black arrow indicating the target arterial lesion (TAL): middle cerebral artery/M1 horizontal segment occlusion (TAL) distal to the lenticulostriate (LS). Black half circles approximate the target downstream territory (TDT; the presumed area supplied by the TAL).

Figure 4

Example of thrombolysis in cerebral infarction (TICI) 0 and TICI 2a (compare with TICI 3 and 2b above). Top, Anteroposterior (first 2 boxes) and lateral (last 2 boxes) in an early arterial and late capillary phases depicting TICI 0 at baseline. Bottom, Same phases depicting TICI 2a after intra-arterial therapy. Black arrow indicating the target arterial lesion (TAL): middle cerebral artery/M1 horizontal segment occlusion (TAL) distal to the lenticulostriate (LS). Black half circles approximate the target downstream territory (TDT; the presumed area supplied by the TAL).

Figure 5

Example of downstream territory (TDT) for an ICA occlusion with pre–intra-arterial therapy (IAT) data from CT angiogram showing cross-filling from the contralateral anterior cerebral artery. Top, Anteroposterior (first 2 boxes) and lateral (last 2 boxes) in an early arterial and late capillary phases depicting thrombolysis in cerebral infarction (TICI) 0 at baseline. Bottom, Same phases depicting TICI 3 after IAT. Black arrow indicating the target arterial lesion (TAL): Distal ICA proximal to the ophthalmic artery. Black half circles approximate the target downstream territory (TDT; the presumed area supplied by the TAL). Early ischemic arteriovenous shunting is noted in the right lower corner.