Abstract 102: Thrombolysis In Cerebral Infarction (TICI) 2b Versus TICI 3 Reperfusion In Stroke Patients With Mild Symptoms

Purpose The therapeutic benefit of mechanical thrombectomy in patients with mild strokesymptoms and large vessel occlusion (LVO) remains unclear. Furthermore, it isuncertain whether achieving complete reperfusion (modified Thrombolysis in CerebralInfarction mTICI 3) offers additional clinical benefit compared to incompletereperfusion (mTICI 2b). Methods In this retrospective, multicenter analysis, all patients enrolled in the German StrokeRegistry – Endovascular Treatment between 2015 and 2023 (n = 18,069) wereevaluated. The study included patients with a National Institutes of Health Stroke Scale(NIHSS) score <6 and anterior circulation LVO. Clinical outcomes were comparedbased on the final angiographic result (mTICI 3 vs. mTICI 2b). The primary endpointwas excellent long‐term functional outcome, defined as a modified Rankin Scale(mRS) score of 0–1 at 90 days. Results Of the 747 included patients, 63% achieved mTICI 3 and 37% mTICI 2b. An excellentfunctional outcome was observed at similar rates in both groups (60% vs. 59%;P=0.83; adjusted OR: 0.90 95% CI: 0.62–1.30, P=0.57). The rates of symptomaticintracranial hemorrhage (3% vs. 4%; P=0.21; adjusted OR: 0.43 95% CI: 0.16–1.20,P=0.11) and 90‐day mortality (7% vs. 10%; P=0.26; adjusted OR: 0.91 95% CI: 0.49–1.68, P=0.75) were also comparable between the two groups. Conclusion Among patients with mild stroke who underwent thrombectomy, complete reperfusion(mTICI 3) was not associated with better functional outcomes compared to incompletereperfusion (mTICI 2b). These findings suggest that mTICI 2b may be an acceptablefinal angiographic result and raise questions about the risk‐benefit ratio of additionalretrieval maneuvers aimed at achieving mTICI 3 in this patient population. image Figure 1. Distribution of the modified Rankin Scale (mRS) score stratified by the finalangiographic result. The mRS ranges from 0 to 6 and assesses functional disabilityafter stroke, with 0 indicating no symptoms and 6 indicating death. The modifiedThrombolysis in Cerebral Infarction (mTICI) score measures reperfusion aftermechanical thrombectomy; mTICI 2b indicates incomplete reperfusion, while TICI 3reflects complete reperfusion.