BACKGROUND: Despite increased recanalization rates in the treatment of acute ischemic stroke, the percentage of patients with a good clinical outcome of all those treated has not risen above 50%. This 50% barrier may be broken by improving the criteria for treatment selection. This study investigated the addition of the capillary index score (CIS), a new index for assessing remaining viable tissue in the ischemic area, to the existing criteria. METHODS: The Borgess Medical Center Ischemic Stroke Registry is a non-randomized single-center single-operator registry of consecutive subjects admitted for intra-arterial treatment of acute ischemic stroke. The CIS was calculated from a pre-intervention catheter cerebral angiogram in subjects with internal carotid artery (ICA) or middle cerebral artery (MCA) (M1) occlusion. Thrombolysis In Myocardial Infarction (TIMI) 2 or 3 was considered successful recanalization. A modified Rankin Scale (mRS) of 0-2 at 3 months was considered a good outcome. RESULTS: ICA or MCA (M1) occlusion was found in 46 of 58 consecutive patients treated by the same operator. Recanalization was successful in 72% of patients and 27% had a good outcome. CIS was available for 26 patients; 42% were favorable (2 or 3) and 58% were poor (0 or 1). A good outcome was found only in the favorable CIS group (p=0.0148). Successful recanalization (p=0.0029) and time from ictus to revascularization (p=0.0039) predicted a good outcome. Of patients with favorable CIS and TIMI 3, 83% had a good outcome. CONCLUSIONS: Favorable CIS and recanalization were strong predictors of a good outcome. By using this new index as an adjunct to other criteria, the CIS may improve patient selection and help break the 50% barrier.
BACKGROUND: Despite increased recanalization rates in the treatment of acute ischemic stroke, the percentage of patients with a good clinical outcome of all those treated has not risen above 50%. This 50% barrier may be broken by improving the criteria for treatment selection. This study investigated the addition of the capillary index score (CIS), a new index for assessing remaining viable tissue in the ischemic area, to the existing criteria. METHODS: The Borgess Medical Center Ischemic Stroke Registry is a non-randomized single-center single-operator registry of consecutive subjects admitted for intra-arterial treatment of acute ischemic stroke. The CIS was calculated from a pre-intervention catheter cerebral angiogram in subjects with internal carotid artery (ICA) or middle cerebral artery (MCA) (M1) occlusion. Thrombolysis In Myocardial Infarction (TIMI) 2 or 3 was considered successful recanalization. A modified Rankin Scale (mRS) of 0-2 at 3 months was considered a good outcome. RESULTS: ICA or MCA (M1) occlusion was found in 46 of 58 consecutive patients treated by the same operator. Recanalization was successful in 72% of patients and 27% had a good outcome. CIS was available for 26 patients; 42% were favorable (2 or 3) and 58% were poor (0 or 1). A good outcome was found only in the favorable CIS group (p=0.0148). Successful recanalization (p=0.0029) and time from ictus to revascularization (p=0.0039) predicted a good outcome. Of patients with favorable CIS and TIMI 3, 83% had a good outcome. CONCLUSIONS: Favorable CIS and recanalization were strong predictors of a good outcome. By using this new index as an adjunct to other criteria, the CIS may improve patient selection and help break the 50% barrier.
Authors: Firas Al-Ali; Thomas A Tomsick; John J Connors; James M Gebel; John J Elias; Georges Z Markarian; Zein Al-Ali; Joseph P Broderick Journal: Stroke Date: 2014-05-22 Impact factor: 7.914
Authors: Manoj Jagani; Waleed Brinjikji; Mohammad H Murad; Alejandro A Rabinstein; Harry J Cloft; David F Kallmes Journal: J Vasc Interv Neurol Date: 2017-01
Authors: C Dargazanli; A Consoli; M Barral; J Labreuche; H Redjem; G Ciccio; S Smajda; J P Desilles; G Taylor; C Preda; O Coskun; G Rodesch; M Piotin; R Blanc; B Lapergue Journal: AJNR Am J Neuroradiol Date: 2016-11-03 Impact factor: 3.825
Authors: Osama O Zaidat; Albert J Yoo; Pooja Khatri; Thomas A Tomsick; Rüdiger von Kummer; Jeffrey L Saver; Michael P Marks; Shyam Prabhakaran; David F Kallmes; Brian-Fred M Fitzsimmons; J Mocco; Joanna M Wardlaw; Stanley L Barnwell; Tudor G Jovin; Italo Linfante; Adnan H Siddiqui; Michael J Alexander; Joshua A Hirsch; Max Wintermark; Gregory Albers; Henry H Woo; Donald V Heck; Michael Lev; Richard Aviv; Werner Hacke; Steven Warach; Joseph Broderick; Colin P Derdeyn; Anthony Furlan; Raul G Nogueira; Dileep R Yavagal; Mayank Goyal; Andrew M Demchuk; Martin Bendszus; David S Liebeskind Journal: Stroke Date: 2013-08-06 Impact factor: 7.914