Impact of expanded Thrombolysis in Cerebral Infarction (eTICI) grades on clinical outcomes in patients with large ischemic strokes receiving endovascular treatment.

Objective: This study aimed to investigate the impact of the expanded Thrombolysis in Cerebral Infarction (eTICI) grades on clinical outcomes after endovascular treatment (EVT) for large ischemic strokes.

Methods: This study was a substudy of a prospective nationwide multicenter registry that included 490 patients with large ischemic strokes undergoing EVT. The primary outcome was a 90-day modified Rankin Scale (mRS) score of 0-3. Secondary outcomes included the distribution of mRS score, and mRS scores of 0-2 and 0-4 at 90 days. Safety outcomes included 90-day mortality and symptomatic intracranial hemorrhage (sICH) within 48 h.

Results: Among 490 patients treated with EVT, 67 (13.7%), 125 (25.5%), and 298 (60.8%) achieved eTICI grades 0-2a, 2b, and 2c-3, respectively. Compared with eTICI grades 0-2a, eTICI grade 2b showed no significant association with an mRS score of 0-3, while eTICI grades 2c-3 were significantly associated with higher odds of achieving an mRS score of 0-3 (adjusted odds ratios [aOR] 3.04, 95% CI 1.39-6.62). Mortality was lower for eTICI grades 2c-3 than for grades 0-2a (aOR 0.47, 95% CI 0.25-0.89). There were no significant differences in sICH rates among three groups. The predicted probability of an mRS score of 0-3 progressively decreased with increasing procedure time, while the predicted probability of mortality progressively increased.

Conclusion: In patients with large ischemic strokes undergoing EVT, eTICI grades 2c-3 were significantly associated with improved clinical outcomes. This study suggests that eTICI grades 2c-3 should be considered the ideal target for successful reperfusion in this patient population.