Citation: Wang, R.; Aslan, A.; Khalili, N.; Garg, T.; Kotha, A.; Hamam, O.; Hoseinyazdi, M.; Yedavalli, V. Groin Puncture to Recanalization Time May Be a Strong Predictor of mTICI 2c/3 over mTICI 2b in Patients with Large Vessel Occlusions Successfully Recanalized with Mechanical Thrombectomy. Diagnostics 2022, 12, 2557. https://doi.org/10.3390/ diagnostics12102557 Academic Editor: Vasileios T. Papaliagkas Received: 14 September 2022 Accepted: 17 October 2022 Published: 21 October 2022 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). diagnostics Communication Groin Puncture to Recanalization Time May Be a Strong Predictor of mTICI 2c/3 over mTICI 2b in Patients with Large Vessel Occlusions Successfully Recanalized with Mechanical Thrombectomy Richard Wang , Alperen Aslan, Neda Khalili, Tushar Garg , Apoorva Kotha , Omar Hamam, Meisam Hoseinyazdi and Vivek Yedavalli * Department of Radiology and Radiological Sciences, Division of Neuroradiology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA * Correspondence: vyedava1@jhmi.edu; Tel.: +1-614-264-0388 Abstract: Mechanical thrombectomy (MT) is an important therapeutic option in the management of acute ischemic stroke (AIS) caused by large vessel occlusions (LVO). While achieving a modified thrombolysis in cerebral infarction (mTICI), grades of 2b, 2c, and 3 are all considered successful recanalization; recent literature suggests that mTICI grades of 2c/3 are associated with superior outcomes than 2b. The aim of this preliminary study is to determine whether any baseline or procedural parameters can predict whether successfully recanalized patients achieve an mTICI grade of 2c/3 over 2b. Consecutive patients from 9/2019 to 10/2021 who were successfully recanalized following MT for confirmed LVO were included in the study. Baseline and procedural data were collected through manual chart review and analyzed to ascertain whether any variables of interest could predict mTICI 2c/3. A total of 47 patients were included in the preliminary study cohort, with 35 (74.5%) achieving an mTICI score of 2c/3 and 12 (25.5%) achieving an mTICI score of 2b. We found that a lower groin puncture to recanalization time was a strong, independent predictor of TICI 2c/3 (p = 0.015). These findings emphasize the importance of minimizing procedure time in achieving superior reperfusion but must be corroborated in larger scale studies. Keywords: stroke; large vessel occlusions; mechanical thrombectomy; neuro-endovascular; mTICI; recanalization 1. Introduction Acute ischemic stroke (AIS) is one of the leading causes of morbidity in the world. Anterior circulation large vessel occlusions (LVOs) cause up to 30% of AIS [1]. In patients presenting with AIS secondary to anterior circulation LVOs, mechanical thrombectomy (MT) is the treatment standard of care if it can be performed within six hours of symptom onset, as well as up to 24 h in selected patients. In these scenarios, MT can lead to smaller infarct volumes and favorable outcomes [2–5]. It is well established that patients who achieve successful recanalization have favorable clinical outcomes. Historically, patients were considered to be successfully recanalized if they achieved a modified thrombolysis in cerebral infarction (mTICI) grade of 2b, 2c, or 3. However, more recent studies have shown that patients who achieve an mTICI grade of 2c/3—considered excellent recanalization—have better outcomes than those who achieve an mTICI grade of 2b [6–9]. Is it therefore of growing interest to better understand which factors separate patients who achieve excellent recanalization from those who only achieve mTICI 2b. A few published studies have examined differences in baseline characteristics between mTICI 2b and 3 cohorts [10,11], but no studies to our knowledge has compared mTICI 2b with a combined mTICI 2c and 3 cohort. Given the much superior outcomes Diagnostics 2022, 12, 2557. https://doi.org/10.3390/diagnostics12102557 https://www.mdpi.com/journal/diagnostics