Measure Information Form

Measure Set: Comprehensive Stroke (CSTK)

Set Measure ID: CSTK-08

Performance Measure Name: Thrombolysis in Cerebral Infarction (TICI Post-Treatment Reperfusion Grade)

Description: Ischemic stroke patients with a post-treatment reperfusion grade of TICI 2B or higher in the vascular territory beyond the target arterial occlusion at the end of mechanical endovascular reperfusion therapy

Rationale: The Thrombolysis in Cerebral Infarction (TICI) Reperfusion Grade is used to measure cerebral reperfusion. Results with this scoring system range between zero and three: 0 (no perfusion); 1 (perfusion past the initial occlusion, but no distal branch filling); 2 (perfusion with incomplete or slow distal branch filling); and, 3 (full perfusion with filling of all distal branches). Reperfusion past the target arterial occlusion and into the distal arterial bed and terminal branches, in conjunction with recanalization of the target arterial occlusion, demonstrates flow restoration or revascularization.

Endovascular thrombectomy (EVT) with a stent retriever is the standard of care for treatment of acute ischemic stroke from anterior circulation proximal large-vessel occlusion (LVO). The use of mechanical thrombectomy devices other than stent retrievers as first-line devices for mechanical thrombectomy may be reasonable in some circumstances, but stent retrievers remain the first choice (Powers W.J., et al., 2018).

Type Of Measure: Outcome

Improvement Noted As: Increase in the rate

Numerator Statement: Ischemic stroke patients with a post-treatment reperfusion grade of TICI 2B or higher

Included Populations: As above
Excluded Populations: None
Data Elements:

Post-Treatment Thrombolysis in Cerebral Infarction (TICI) Reperfusion Grade

Denominator Statement: Ischemic stroke patients treated with mechanical endovascular reperfusion therapy

Included Populations:

Discharges with ICD-10-CM Principal Diagnosis Code for ischemic stroke as defined in Appendix A, Table 8.1 for ICD-10 codes,
AND

Patients with documented Mechanical Endovascular Reperfusion Therapy (ICD-10-PCS Principal or Other Procedure Codes as defined in Appendix A, Table 8.1b for ICD-10 codes),
OR

Patients with documented Failed Attempt at Thrombectomy (ICD-10-PCS Principal or Other Procedure Codes as defined in Appendix A, Table 8.1c for ICD-10 codes)

Excluded Populations:

Patients less than 18 years of age

Patients who have a Length of Stay > 120 days

Patients admitted for Elective Carotid Intervention

Data Elements:

Admission Date

Birthdate

Discharge Date

Elective Carotid Intervention

Failed Attempt at Thrombectomy

ICD-10-CM Principal Diagnosis Code

ICD-10-PCS Other Procedure Codes

ICD-10-PCS Other Procedure Dates

ICD-10-PCS Principal Procedure Code

ICD-10-PCS Principal Procedure Date

Risk Adjustment: Suspended. This section has been moved to the ORYX Risk Adjustment Guide. The guide is available to the public on Joint Commission's website.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records.

Data Accuracy: Variation may exist in the assignment of ICD-10 codes; therefore, coding practices may require evaluation to ensure consistency.

Measure Analysis Suggestions: None

Sampling: Yes. Please refer to the measure set specific sampling requirements and for additional information see the Population and Sampling Specifications section.

Data Reported As: Aggregate rate generated from count data reported as a proportion.

Selected References:

Campbell, B. C. V., Mitchell, P. J., Kleinig, T. J., Dewey, H. M., Churilov, L., Yassi, N., et al. (2015). Endovascular therapy for ischemic stroke with perfusion imaging selection. The New England Journal of Medicine, 372 (11), 1009–1017.
Demchuk, A. M., Goyal, M., Menon, B. K., Eesa, M., Ryckborst, K. J., Kamal, N., et al. (2015). Endovascular treatment for small core and anterior circulation proximal occlusion with emphasis on minimizing CT to recanalization times (ESCAPE) trial: Methodology. International Journal of Stroke, 10 (3), 429–438.
Leifer, D., Bravata, D. M., Connors, J. J., III, Hinchey, J. A., Jauch, E. C., Johnston, S. C., Latchaw, R., Likosky, W., Ogilvy, C., Qureshi, A. I., Summers, D., Sung, G. Y., Williams, L. S., & Zorowitz, R., on behalf of the American Heart Association Special Writing Group of the Stroke Council, Atherosclerotic Peripheral Vascular Disease Working Group and Council on Cardiovascular Surgery and Anesthesia, and Council on Cardiovascular Nursing. (2011). Metrics for measuring quality of care in comprehensive stroke centers: Detailed follow-up to Brain Attack Coalition comprehensive stroke center recommendations: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 42, 853-54.
Menon, B. K., Saver, J. L., Prabhakaran, S., Reeves, M., Liang, L., Olson, D. W. M., Peterson, E. D., Hernandez, A. F., Fonarow, G. C., Schwamm, L. H., & Smith, E. E. (2012). Risk score for intracranial hemorrhage in patients with acute ischemic stroke treated with intravenous tissue type plasminogen activator. Stroke, 43, 1–9.
Powers, W. J., Derdeyn, C. P., Biller, J., Coffey, C. S., Jauch, E. C., Johnston, K. C., Johnston, S. C., Khalessi, A. A., Kidwell, C. S., Meschia, J. F., Ovbiagele, B., & Yavagal, D. R., on behalf of the American Heart Association Stroke Council. (2015). 2015 AHA/ASA focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 46, 3021–3035.
Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., Biller, J., et al., on behalf of the American Heart Association Stroke Council. (2018). 2018 guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 49, e10–e11, e26–e30.
Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., Biller, J., et al. (2019). Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke—A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 50 (12), e344–e418.
Prabhakaran, S., Gonzalez, N. R., Zachrison, K. S., Adeoye, O., Alexandrov, A. W., Ansari, S. A., Chapman, S., Czap, A. L., Dumitrascu, O. M., Ishida, K., Jadhav, A. P., Johnson, B., Johnston, K. C., Khatri, P., Kimberly, W. T., Lee, V. H., Leslie-Mazwi, T. M., Mac Grory, B., Madsen, T. E., Menon, B., Mistry, E. A., Park, S., Parker, S., Pérez de la Ossa, N., Reeves, M., Saiz, T., Scott, P. A., Schwartzberg, D., Sheth, S. A., Sporns, P. B., Times, S., Tjoumakaris, S., Wolfe, S. Q., & Yaghi, S.; Peer Review Committee Collaborators. (2026). 2026 guideline for the early management of patients with acute ischemic stroke: A guideline from the American Heart Association/American Stroke Association. Stroke. Advance online publication. https://doi.org/10.1161/STR.0000000000000513
Saver, J. L., Goyal, M., Bonafe, A., Diener, H.-C., Levy, E. I., Pereira, V. M., et al. (2015). Stent retriever thrombectomy after intravenous t PA vs. t PA alone in stroke. The New England Journal of Medicine, 372 (24), 2285–2295.

Measure Algorithm:
Graphic depiction of the Measure Algorithm. Refer to the Algorithm Narrative for each detailed step.

CSTK-08: Algorithm Narrative

CSTK-08: Thrombolysis in Cerebral Infarction (TICI) Post-Treatment Reperfusion Grade

Numerator: Ischemic stroke patients with a post-treatment reperfusion grade of TICI 2B or higher.
Denominator: Ischemic stroke patients treated with mechanical endovascular reperfusion therapy.

1. Start processing. Run cases, which are included in the Comprehensive Stroke Initial Patient Population and pass the edits defined in the Clinical Data Processing Flow, through this measure.

2. Check ICD-10 CM Principal Diagnosis Code

If ICD-10 CM Principal Diagnosis Code is not on Table 8.1, the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Stop processing.
If ICD-10 CM Principal Diagnosis Code is on Table 8.1, continue processing and proceed to check Elective Carotid Intervention.

3. Check Elective Carotid Intervention.

If Elective Carotid Intervention is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
If Elective Carotid Intervention equals Y the case will proceed to a Measure Category Assignment of B and will not be in the Measure Population. Stop processing.
If Elective Carotid Intervention equals N continue processing and proceed to check Failed Attempt at Thrombectomy .

4. Check Failed Attempt at Thrombectomy.

If Failed Attempt at Thrombectomy is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
If Failed Attempt at Thrombectomy equals Y the case will proceed to a Measure Category Assignment of D and will be in the Measure Population. Stop processing.
If Failed Attempt at Thrombectomy equals N continue processing and proceed to check ICD-10-PCS Principal or Other Procedure Codes.

5. Check ICD-10-PCS Principal or Other Procedure Codes.

If ICD-10-PCS Principal or Other Procedure Codes equals All Missing or None on Table 8.1b, the case will proceed to a Measure Category Assignment of B and will be in Not in Measure Population. Stop processing.
If ICD-10-PCS Principal or Other Procedure Codes equals Any on Table 8.1b continue processing and proceed to check Post-Treatment Thrombolysis in Cerebral Infarction (TICI) Reperfusion Grade.

6. Check Post-Treatment Thrombolysis in Cerebral Infarction (TICI) Reperfusion Grade.

If Post-Treatment Thrombolysis in Cerebral Infarction (TICI) Reperfusion Grade is missing, the case will proceed to a Measure Category Assignment of X and will be rejected. Stop processing.
If Post-Treatment Thrombolysis in Cerebral Infarction (TICI) Reperfusion Grade equals 2 or 3, the case will proceed to a Measure Category Assignment of D and will be in the Measure Population. Stop processing.
If Post-Treatment Thrombolysis in Cerebral Infarction (TICI) Reperfusion Grade equals 1 the case will be in the Numerator Population. Stop processing.
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Specifications Manual for Joint Commission National Quality Measures (v2027A)
Discharges 01-01-2027 (1Q27) through 06-30-2027 (2Q27)

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