![]() ![]() We qualitatively assessed whether the definition of TICI in each article adhered to the original definition of the TICI scale and evaluated the articles that were cited when TICI was described. We excluded articles that did not relate to the TICI scale (115 articles) and articles that were in languages other than English or that were not accessible in full length (49 articles). With our literature search, we identified a total of 236 articles. Finally, grade 3 is defined as complete perfusion and applies when “antegrade flow into the bed distal to the obstruction occurs as promptly as into the obstruction and clearance of the contrast material from the involved bed is as rapid as from an uninvolved other bed of the same vessel or the opposite cerebral artery.” 2 A grade of 2a indicates partial filling (less than two-thirds) of the entire vascular territory and 2b indicates complete filling of the expected vascular territory, but with a perceptibly slower filling rate than normal. The opposite cerebral artery or the arterial bed proximal to the occlusion can be used for comparison rates. 2 Grade 1 is defined as penetration with minimal perfusion” and applies when the “contrast material passes beyond the area of obstruction but fails to opacify the entire cerebral bed distal to the obstruction.” Grade 2 is broadly defined as partial perfusion, which occurs when the contrast material passes beyond the obstruction, opacifies the distal arterial bed, but the rate of entry of contrast and/or its rate of clearance from the vascular bed are slower than comparable areas not perfused by the previously occluded vessel. In the initial description of the TICI scale in 2003, grade 0 indicates no perfusion as evidenced by no antegrade flow beyond the point of arterial occlusion. ![]() In addition, we reviewed the reference list from all identified articles to identify other papers by using graded response scales for cerebral perfusion, whether or not these papers referenced or utilized the original TICI paper. We searched for the terms “TICI” and “thrombolysis in cerebral infarction.” We also used these databases to search for all articles from January 2004 through May 2012 that cited the original TICI paper. We performed a search of the medical literature by using the ISI Web of Knowledge and SciVerse Scopus databases. Although the TICI scale has achieved fairly rapid acceptance into the medical literature, the scale was somewhat arbitrarily created and has not been validated or tested systematically. The “partial perfusion” category (grade 2) is defined as cases in which contrast passes the obstruction but with rates of entry and washout slower than normal and is subdivided into 2 subcategories, 2a and 2b. As originally described, TICI categories span from no perfusion (grade 0) to complete perfusion (grade 3). This new scale, the Thrombolysis in Cerebral Infarction scale, was intended to standardize the grading of angiographic outcomes, particularly for trials of endovascular treatment of acute ischemic stroke ( Table 1). 1 In 2003, Higashida et al 2 proposed a seemingly simple modification of the TIMI scale to evaluate intracranial perfusion assessed in cerebral angiography. The Thrombolysis in Myocardial Infarction scale is a widely applied, graded response scale for assessment of treatment outcome in the coronary arteries. ABBREVIATIONS: TICI Thrombolysis in Cerebral Infarction TIMI Thrombolysis in Myocardial Infarction ![]()
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