TY - JOUR
T1 - Acute ischemic stroke treatment, part 1
T2 - Patient selection: "The 50% barrier and the capillary index score"
AU - Al-Ali, Firas
AU - Elias, John J.
AU - Filipkowski, Danielle E.
AU - González, Ramón Gilberto
AU - Faber, James E.
N1 - Publisher Copyright:
© 2015 Al-ali, Elias, Filipkowski, Gilberto_gonzález and Faber.
PY - 2015
Y1 - 2015
N2 - The current strategy for intra-arterial treatment (IAT) of acute ischemic stroke focuses on minimizing time from ictus to revascularization and maximizing revascularization. Employing this strategy has yet to lead to improved rates of successful outcomes, however. The collateral blood supply likely plays a significant role in maintaining viable brain tissue during ischemia. Based on our prior work, we believe that only approximately 50% of patients are genetically predisposed to have sufficient collaterals for a good outcome following treatment, a concept we call the 50% barrier. The Capillary Index Score (CIS) has been developed as a tool to identify patients with a sufficient collateral blood supply to maintain tissue viability prior to treatment. Patients with a favorable CIS (fCIS) may be able to achieve a good outcome with IAT beyond an arbitrary time window. The CIS is incorporated into a proposed patient treatment algorithm. For patients suffering from a large stroke without aphasia, a non-enhanced head CT should be followed by CT angiography (CTA). For patients without signs of stroke mimics or visible signs of structural changes due to large irreversible ischemia, CTA can help confirm the vascular occlusion and location. The CIS can be obtained from a diagnostic cerebral angiogram (DCA), with IAT offered to patients categorized as fCIS.
AB - The current strategy for intra-arterial treatment (IAT) of acute ischemic stroke focuses on minimizing time from ictus to revascularization and maximizing revascularization. Employing this strategy has yet to lead to improved rates of successful outcomes, however. The collateral blood supply likely plays a significant role in maintaining viable brain tissue during ischemia. Based on our prior work, we believe that only approximately 50% of patients are genetically predisposed to have sufficient collaterals for a good outcome following treatment, a concept we call the 50% barrier. The Capillary Index Score (CIS) has been developed as a tool to identify patients with a sufficient collateral blood supply to maintain tissue viability prior to treatment. Patients with a favorable CIS (fCIS) may be able to achieve a good outcome with IAT beyond an arbitrary time window. The CIS is incorporated into a proposed patient treatment algorithm. For patients suffering from a large stroke without aphasia, a non-enhanced head CT should be followed by CT angiography (CTA). For patients without signs of stroke mimics or visible signs of structural changes due to large irreversible ischemia, CTA can help confirm the vascular occlusion and location. The CIS can be obtained from a diagnostic cerebral angiogram (DCA), with IAT offered to patients categorized as fCIS.
KW - Acute ischemic stroke
KW - Capillary index score (CIS)
KW - Intra-arterial treatment
KW - Patient selection
KW - Revascularization
KW - Stroke outcome
KW - The 50% barrier
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U2 - 10.3389/fneur.2015.00083
DO - 10.3389/fneur.2015.00083
M3 - Article
AN - SCOPUS:84926475083
SN - 1664-2295
VL - 6
JO - Frontiers in Neurology
JF - Frontiers in Neurology
IS - MAR
M1 - 083
ER -