Acute Ischemic Stroke Treatment, Part 2: Treatment "Roles of Capillary Index Score, Revascularization and Time"

Area of Science:

• Neurology
• Interventional Radiology
• Stroke Medicine

Background:

• Clinical trials for intra-arterial treatment for acute ischemic stroke (IAT-AIS) have yielded mixed results regarding good clinical outcomes (GCOs).
• While intra-arterial treatment (IAT) improves revascularization rates, this has not consistently translated into better patient outcomes.
• Poor patient selection is suspected as a reason for suboptimal results in IAT-AIS.

Purpose of the Study:

• To introduce and evaluate the capillary index score (CIS) as a tool for improving patient selection in IAT-AIS.
• To determine if using CIS can enhance the likelihood of good clinical outcomes following revascularization.
• To propose a shift from time-based selection criteria to tissue viability assessment for IAT-AIS.

Main Methods:

• Literature review to identify factors limiting GCOs in IAT-AIS.
• Analysis of the capillary index score (CIS) as an angiography-based marker of tissue viability.
• Proposed use of CIS to select patients for IAT, focusing on residual viable tissue indicated by capillary blush.

Main Results:

• The CIS assesses capillary blush to differentiate viable from non-viable ischemic tissue.
• Absence of blush on angiography indicates non-viable tissue, suggesting futility of revascularization.
• Selecting patients with a favorable CIS is predicted to increase GCOs to 80-90%.

Conclusions:

• Current time-dependent selection for IAT-AIS may not be optimal due to inter-patient variability in ischemic progression.
• The CIS offers a more accurate method for patient selection by directly assessing tissue viability.
• Implementing CIS-based selection could significantly improve treatment efficacy and patient outcomes in IAT-AIS.