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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

The capillary index score: rethinking the acute ischemic stroke treatment algorithm. Results from the Borgess Medical

Firas Al-Ali1, Anne Jefferson, Tom Barrow

  • 1Neurointerventional Surgery and Diagnostic Services, Borgess Medical Center, Kalamazoo, Michigan 49048, USA. firasalali@aol.com

Journal of Neurointerventional Surgery
|January 24, 2012
PubMed

Insights

The capillary index score (CIS) can improve patient selection for acute ischemic stroke treatment. A favorable CIS, along with successful recanalization, predicts better clinical outcomes, potentially breaking the 50% outcome barrier.

Area of Science:

  • Neurology
  • Interventional Neuroradiology
  • Stroke Medicine

Background:

  • Acute ischemic stroke treatment has improved recanalization rates, but good clinical outcomes remain below 50%.
  • Enhanced patient selection criteria are needed to improve treatment efficacy.
  • The capillary index score (CIS) is a novel index assessing viable tissue in ischemic areas.

Purpose of the Study:

  • To investigate the utility of the capillary index score (CIS) as an adjunct to existing criteria for selecting patients for acute ischemic stroke treatment.
  • To determine if CIS can help improve the rate of good clinical outcomes in treated patients.

Main Methods:

  • A non-randomized, single-center registry of patients undergoing intra-arterial treatment for acute ischemic stroke.
  • CIS was calculated from pre-intervention cerebral angiograms in patients with internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion.
  • Good outcome was defined as a modified Rankin Scale (mRS) score of 0-2 at 3 months; successful recanalization was TIMI 2 or 3.

Main Results:

  • Of 46 patients with ICA or MCA (M1) occlusion, 72% achieved successful recanalization, and 27% had a good outcome.
  • A favorable CIS (2 or 3) was present in 42% of patients; good outcomes occurred exclusively in this group (p=0.0148).
  • Successful recanalization (p=0.0029) and shorter time to revascularization (p=0.0039) predicted good outcomes. Patients with favorable CIS and TIMI 3 recanalization had an 83% good outcome rate.

Conclusions:

  • Favorable capillary index score (CIS) and successful recanalization are strong predictors of good clinical outcomes in acute ischemic stroke.
  • Incorporating CIS into patient selection criteria may enhance treatment effectiveness and help surpass the 50% good outcome threshold.
Abstract

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