What is meant by "TICI"?

BACKGROUND: In 2003, Higashida et al proposed the Thrombolysis In Cerebral Infarction scale to evaluate angiographic intracranial flow. Our aim is to review how subsequently published studies define TICI. MATERIALS AND METHODS: We used the ISI Web of Knowledge and SciVerse Scopus databases to search for "TICI" and "thrombolysis in cerebral infarction" and for articles that cited the original TICI paper from January 2004 through May 2012. Articles were categorized according to their definition of the TICI categories, typically grades 0-4, with grade 2 (partial reperfusion) subdivided into 2a and 2b, and rate of contrast entry to the perfused area. In addition, we catalogued the type of redefinitions of TICI subcategory 2 and additions of new categories. RESULTS: Of 236 articles screened, 74 were included. Eight (11%) explicitly followed the TICI scale as originally defined. Thirty-seven (50%) cited Higashida but did not define their scale. Fifteen (21%) used and explained modified scales. Thirteen (18%) used the term TICI, but did not define the scale and did not cite Higashida. Eighteen (24%) specified a 2a subcategory. Nine defined grade 2a as <67% filling, 6 defined it as <50%, and 3 did not offer a percentage. Two studies added a 2c subcategory. Fifty-two (70%) used a cutoff level to define "successful reperfusion." Of these, 65% used TICI ≥2, 33% used TICI ≥2b, and 2% used TICI = 3. CONCLUSIONS: There is substantial variability in the definition and/or application of the TICI scale in the literature. This variability could considerably impact our understanding of results of revascularization studies.

Endovascular therapy of acute ischemic stroke: report of the Standards of Practice Committee of the Society of NeuroInterventional Surgery.

OBJECTIVE: To summarize and classify the evidence for the use of endovascular techniques in the treatment of patients with acute ischemic stroke. METHODS: Recommendations previously published by the American Heart Association (AHA) (Guidelines for the early management of adults with ischemic stroke (Circulation 2007) and Scientific statement indications for the performance of intracranial endovascular neurointerventional procedures (Circulation 2009)) were vetted and used as a foundation for the current process. Building on this foundation, a critical review of the literature was performed to evaluate evidence supporting the endovascular treatment of acute ischemic stroke. The assessment was based on guidelines for evidence based medicine proposed by the Stroke Council of the AHA and the University of Oxford, Centre for Evidence Based Medicine (CEBM). Procedural safety, technical efficacy and impact on patient outcomes were specifically examined.

Accuracy of the new ICD-9-CM code for "drip-and-ship" thrombolytic treatment in patients with ischemic stroke.

A new International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code, V45.88, was approved by the Centers for Medicare and Medicaid Services (CMS) on October 1, 2008. This code identifies patients in whom intravenous (IV) recombinant tissue plasminogen activator (rt-PA) is initiated in one hospital's emergency department, followed by transfer within 24 hours to a comprehensive stroke center, a paradigm commonly referred to as "drip-and-ship." This study assessed the use and accuracy of the new V45.88 code for identifying ischemic stroke patients who meet the criteria for drip-and-ship at 2 advanced certified primary stroke centers. Consecutive patients over a 12-month period were identified by primary ICD-9-CM diagnosis codes related to ischemic stroke. The accuracy of V45.88 code utilization using administrative data provided by Health Information Management Services was assessed through a comparison with data collected in prospective stroke registries maintained at each hospital by a trained abstractor. Out of a total of 428 patients discharged from both hospitals with a diagnosis of ischemic stroke, 37 patients were given ICD-9-CM code V45.88. The internally validated data from the prospective stroke database demonstrated that a total of 40 patients met the criteria for drip-and-ship. A concurrent comparison found that 92% (sensitivity) of the patients treated with drip-and-ship were coded with V45.88. None of the non-drip-and-ship stroke cases received the V45.88 code (100% specificity). The new ICD-9-CM code for drip-and-ship appears to have high specificity and sensitivity, allowing effective data collection by the CMS.

Trombolisis en la disfunción aguda de la fístula arteriovenosa: presentación de un caso

La enfermedad renal crónica representa un problema de salud pública en todo el mundo. La hemodiálisis es la modalidad utilizada con mayor frecuencia en el tratamiento de estos pacientes en estadio terminal. La obtención de un buen acceso vascular es la clave para obtener unos buenos niveles de depuración renal. La trombosis de la fístula es la mayor complicación del acceso vascular. Restablecer la permeabilidad del acceso vascular trombozado consiguiendo un flujo adecuado para una hemodiálisis efectiva, detectar las posibles causas subyacentes de trombosis, fundamentalmente estenosis, y proceder a su corrección debe ser el objetivo fundamental del tratamiento de esta complicación. Se presentó un caso con disfunción aguda de la FAV para hemodiálisis en el Hospital General Augusto César Sandino, se le realizó la trombolisis de rescate efectiva con estreptoquinasa recombinante; se explicó el tratamiento y dosis empleadas, el paciente no presentó complicaciones. Se llegó a la conclusión de que es de gran utilidad el hecho de realizar un rápido y adecuado diagnóstico para la realización de dicho proceder, donde es posible lograr resultados muy satisfactorios...(AU)

Chronic renal failure represents a public health problem all over the world. Hemodialysis is the most frequent modality of treatment in terminal stage patients. The achievement of a good vascular approach is the key to obtain proper levels of renal clearance. The thrombosis of the fistula is the major complication of vascular access. Permeability recovery of thrombosed vascular access to obtain an adequate flow to an accurate Hemodialysis together with the detection of possible underlying causes of thrombosis, mainly stenosis, and then to correct it, should be the basic objective when treating this complication. A case presenting acute dysfunction of Arteriovenous Fistula to carry out Hemodialysis was reported at Agusto Cesar Sandino General Hospital. A successful rescue thrombolysis with recombinant streptokinase was performed, explaining the treatment and dosage used without complications. An adequate and rapid diagnosis is very useful to carry out the procedure in order to achieve satisfactory results...(AU)

Tratamiento percutáneo de las complicaciones vasculares agudas en el síndrome de la abertura torácica superior / Percutaneous treatment of acute vascular complications in thoracic outlet syndrome

Objetivo: Presentar los resultados obtenidos en el tratamiento percutáneo de las complicaciones vasculares agudas del síndrome de la abertura torácica superior (SATS). Materiales y métodos: Dieciséis pacientes presentaron complicaciones vasculares agudas (12 casos de carácter venoso y cuatro de origen arterial) del SATS. En todos ellos se efectuaron radiografías simples de cuello y tórax para descartar anomalías óseas cérvico-torácicas, así como el estudio angiográfico correspondiente. En función de la clínica y de los hallazgos radiológicos, el tratamiento consistió en fibrinólisis, angioplastia transluminal (ATP) o cirugía. Resultados: Ninguno de los pacientes con complicaciones venosas presentaba anomalías cérvico-torácicas. De ellos, 10 fueron tratados con fibrinolíticos, obteniéndose repermeabilización venosa en todos los casos, con trombosis mural residual inferior al 50 por ciento de la luz en tres pacientes. La ATP se efectuó en cinco pacientes, con resolución completa de la estenosis en dos casos y parcial en los otros tres, produciéndose como complicación hematoma mural en un paciente. De los cuatro pacientes con complicaciones arteriales, tres presentaban costilla cervical. A uno de ellos se le administró urocinasa con buena respuesta clínico-radiológica. Todos los pacientes fueron intervenidos con resolución completa de su sintomatología. Conclusión: El tratamiento fibrinolítico presenta una gran efectividad en el manejo inicial de las complicaciones vasculares del SATS. (AU)

Trombosis venosa cerebral. tratamiento mediante fibrinolisis local con alteplasa / Cerebral venous thrombosis: treatment with local fibrinolysis plus alteplase

La trombosis venosa cerebral es una rara entidad con manifestaciones clínicas muy diversas, por lo que su diagnóstico requiere un alto índice de sospecha. Afecta a los senos durales con o sin extensión a las venas cerebrales. Tradicionalmente el diagnóstico se ha basado en el estudio angiográfico, aunque en la actualidad, se imponen nuevas técnicas de imagen no invasivas como la tomografía computarizada (TC), la resonancia magnética (RM) y la angio-RM.El tratamiento debe comprender una terapia sintomática y etiológica. Aunque parece razonable anticoagular a estos pacientes, esto es fuente de controversia. Al igual que en otros procesos como el tromboembolismo pulmonar y la trombosis coronaria, la aparición de nuevos y cada vez más seguros fármacos fibrinolíticos, junto con innovaciones técnicas en el campo de la neurorradiología intervencionista, permiten una nueva perspectiva en el manejo de estos pacientes. Presentamos un caso de una paciente de 43 años de edad con trombosis del seno recto que fue tratada mediante trombolisis local con alteplasa (activador tisular del plasminógeno). Se describe la técnica realizada y se revisa la bibliografía al respecto (AU)

Clinical controversies surrounding thrombolytic therapy in acute myocardial infarction.

The treatment of acute myocardial infarction has changed tremendously in the past decade because thrombolytic therapy has become the treatment of choice for the patient with acute myocardial infarction. Although many issues have been resolved, several controversial issues remain unresolved. This article addresses thrombolytic agents in terms of their superiority in achieving infarct vessel patency and mortality reduction as well as the role of thrombolysis in patients who present with chest pain of greater than 6 hours' duration, who are elderly, and who have an inferior infarction.