NEUROIMAGING / NEUROSONOLOGY

Thrombolysis in Brain Ischemia (TIBI)

Updated on 20/09/2023, published on 14/02/2023

  • the TIBI classification was developed to grade residual flow
  • it correlates with initial stroke severity, clinical recovery, and mortality in acute stroke patients
    • no improvement in the residual flow correlates with the absence of early clinical recovery and increased mortality  (Demchuk, 2012)
TIBI 0
TIBI 0 – absent flow
– lack of regular pulsatile flow signals despite varying degrees of background noise
TIBI 1
TIBI 1 – minimal flow
– systolic spikes of variable velocity and duration
– EDV = 0
– possible reverberating flow
TIBI 2
TIBI 2 – blunted flow
– flattened systolic flow acceleration of variable duration compared to control side
– PI < 1,2
– positive EDV
TIBI 3
TIBI 3 – dampened flow
– normal systolic flow acceleration
– positive EDV
– decreased flow (MFV) by > 30% compared to the control (healthy) side
TIBI 4
TIBI 4 – stenotic flow
– MFV > 80cm/s + velocity difference (MFV) of > 30% compared to the control side (increased velocity)
– turbulence  + velocity difference (MFV) of > 30% compared to the control side (increased velocity)
TIBI 5 TIBI 5 – normal flow
– symmetrical flow or < 30% MFV difference compared to the control side

According to  [Demchuk, 2001]

 Recanalization assessment  [Clotbust, 2007]
Complete recanalization   TIBI 4-5
Parcial recanalization  increase of TIBI by ≥1 grade (but not to 4 or 5)
Reocclusion  decrease of TIBI by ≤1 grade
Post-IVT full recanalizatiin (TIBI 1 to TIBI 5)

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Thrombolysis in Brain Ischemia (TIBI)
link: https://www.stroke-manual.com/thrombolysis-in-brain-ischemia-tibi/