Revascularization grading in endovascular acute ischemic stroke therapy

O. O. Zaidat, M. A. Lazzaro, D. S. Liebeskind, N. Janjua, L. Wechsler, R. G. Nogueira, R. C. Edgell, J. S. Kalia, A. Badruddin, J. English, D. Yavagal, J. F. Kirmani, Andrei Alexandrov, P. Khatri

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Background: Recanalization and angiographic reperfusion are key elements to successful endovascular and interventional acute ischemic stroke (AIS) therapy. Intravenous recombinant tissue plasminogen activator (rt-PA), the only established revascularization therapy approved by the US Food & Drug Administration for AIS, may be less effective for large artery occlusion. Thus, there is enthusiasm for endovascular revascularization therapies, which likely provide higher recanalization rates, and trials are ongoing to determine clinical efficacy and compare various methods. It is anticipated that clinical efficacy will be well correlated with revascularization of viable tissue in a timely manner. Method: Reporting, interpretation, and comparison of the various revascularization grading methods require agreement on measurement criteria, reproducibility, ease of use, and correlation with clinical outcome. These parameters were reviewed by performing a Medline literature search from 1965 to 2011. This review critically evaluates current revascularization grading systems. Results and Conclusion: The most commonly used revascularization grading methods in AIS interventional therapy trials are the thrombolysis in cerebral ischemia (TICI, pronounced "tissy") and thrombolysis in myocardial ischemia (TIMI) scores. Until further technical and imaging advances can incorporate real-time reliable perfusion studies in the angio-suite to delineate regional perfusion more accurately, the TICI grading system is the best defined and most widely used scheme. Other grading systems may be used for research and correlation purposes. A new scale that combines primary site occlusion, lesion location, and perfusion should be explored in the future.

Original languageEnglish (US)
JournalNeurology
Volume79
Issue number13 SUPPL. 1
DOIs
StatePublished - Sep 25 2012

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Stroke
Perfusion
Tissue Plasminogen Activator
Therapeutics
Brain Ischemia
Reperfusion
Myocardial Ischemia
Arteries
Food
Research
Pharmaceutical Preparations

All Science Journal Classification (ASJC) codes

  • Clinical Neurology

Cite this

Zaidat, O. O., Lazzaro, M. A., Liebeskind, D. S., Janjua, N., Wechsler, L., Nogueira, R. G., ... Khatri, P. (2012). Revascularization grading in endovascular acute ischemic stroke therapy. Neurology, 79(13 SUPPL. 1). https://doi.org/10.1212/WNL.0b013e3182695916

Revascularization grading in endovascular acute ischemic stroke therapy. / Zaidat, O. O.; Lazzaro, M. A.; Liebeskind, D. S.; Janjua, N.; Wechsler, L.; Nogueira, R. G.; Edgell, R. C.; Kalia, J. S.; Badruddin, A.; English, J.; Yavagal, D.; Kirmani, J. F.; Alexandrov, Andrei; Khatri, P.

In: Neurology, Vol. 79, No. 13 SUPPL. 1, 25.09.2012.

Research output: Contribution to journalArticle

Zaidat, OO, Lazzaro, MA, Liebeskind, DS, Janjua, N, Wechsler, L, Nogueira, RG, Edgell, RC, Kalia, JS, Badruddin, A, English, J, Yavagal, D, Kirmani, JF, Alexandrov, A & Khatri, P 2012, 'Revascularization grading in endovascular acute ischemic stroke therapy', Neurology, vol. 79, no. 13 SUPPL. 1. https://doi.org/10.1212/WNL.0b013e3182695916
Zaidat OO, Lazzaro MA, Liebeskind DS, Janjua N, Wechsler L, Nogueira RG et al. Revascularization grading in endovascular acute ischemic stroke therapy. Neurology. 2012 Sep 25;79(13 SUPPL. 1). https://doi.org/10.1212/WNL.0b013e3182695916
Zaidat, O. O. ; Lazzaro, M. A. ; Liebeskind, D. S. ; Janjua, N. ; Wechsler, L. ; Nogueira, R. G. ; Edgell, R. C. ; Kalia, J. S. ; Badruddin, A. ; English, J. ; Yavagal, D. ; Kirmani, J. F. ; Alexandrov, Andrei ; Khatri, P. / Revascularization grading in endovascular acute ischemic stroke therapy. In: Neurology. 2012 ; Vol. 79, No. 13 SUPPL. 1.
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AU - Lazzaro, M. A.

AU - Liebeskind, D. S.

AU - Janjua, N.

AU - Wechsler, L.

AU - Nogueira, R. G.

AU - Edgell, R. C.

AU - Kalia, J. S.

AU - Badruddin, A.

AU - English, J.

AU - Yavagal, D.

AU - Kirmani, J. F.

AU - Alexandrov, Andrei

AU - Khatri, P.

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AB - Background: Recanalization and angiographic reperfusion are key elements to successful endovascular and interventional acute ischemic stroke (AIS) therapy. Intravenous recombinant tissue plasminogen activator (rt-PA), the only established revascularization therapy approved by the US Food & Drug Administration for AIS, may be less effective for large artery occlusion. Thus, there is enthusiasm for endovascular revascularization therapies, which likely provide higher recanalization rates, and trials are ongoing to determine clinical efficacy and compare various methods. It is anticipated that clinical efficacy will be well correlated with revascularization of viable tissue in a timely manner. Method: Reporting, interpretation, and comparison of the various revascularization grading methods require agreement on measurement criteria, reproducibility, ease of use, and correlation with clinical outcome. These parameters were reviewed by performing a Medline literature search from 1965 to 2011. This review critically evaluates current revascularization grading systems. Results and Conclusion: The most commonly used revascularization grading methods in AIS interventional therapy trials are the thrombolysis in cerebral ischemia (TICI, pronounced "tissy") and thrombolysis in myocardial ischemia (TIMI) scores. Until further technical and imaging advances can incorporate real-time reliable perfusion studies in the angio-suite to delineate regional perfusion more accurately, the TICI grading system is the best defined and most widely used scheme. Other grading systems may be used for research and correlation purposes. A new scale that combines primary site occlusion, lesion location, and perfusion should be explored in the future.

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