Predictors of mTICI 2c/3 over 2b in patients successfully recanalized with mechanical thrombectomy

Objective: For patients presenting with acute ischemic stroke (AIS) caused by large vessel occlusions (LVO), mechanical thrombectomy (MT) is the treatment standard of care in eligible patients. Modified Thrombolysis in Cerebral Infarction (mTICI) grades of 2b, 2c, and 3 are all considered successful reperfusion; however, recent studies have shown achieving mTICI 2c/3 leads to better outcomes than mTICI 2b. This study aims to investigate whether any baseline preprocedural or periprocedural parameters are predictive of achieving mTICI 2c/3 in successfully recanalized LVO patients. Methods: We conducted a retrospective multicenter cohort study of consecutive patients presenting with AIS caused by a LVO from 1 January 2017 to 1 January 2023. Baseline and procedural data were collected through chart review. Univariate and multivariate analysis were applied to determine significant predictors of mTICI 2c/3. Results: A total of 216 patients were included in the study, with 159 (73.6%) achieving mTICI 2c/3 recanalization and 57 (26.4%) achieving mTICI 2b recanalization. We found that a higher groin puncture to first pass time (OR = 0.976, 95%CI: 0.960–0.992, p = 0.004), a higher first pass to recanalization time (OR = 0.985, 95%CI: 0.972–0.998, p = 0.029), a higher admission NIHSS (OR = 0.949, 95%CI: 0.904–0.995, p = 0.031), and a lower age (OR = 1.032, 95%CI: 1.01–1.055, p = 0.005) were associated with a decreased probability of achieving mTICI 2c/3. Interpretation: A lower groin puncture to first pass time, a lower first pass to recanalization time, a lower admission NIHSS, and a higher age were independent predictors of mTICI 2c/3 recanalization.