Acute ischemic stroke treatment, part 1: Patient selection: "The 50% barrier and the capillary index score"

Firas Al-Ali, John J. Elias, Danielle E. Filipkowski, Ramón Gilberto González, James E. Faber

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Article number083
JournalFrontiers in Neurology
Volume6
Issue numberMAR
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

Keywords

  • Acute ischemic stroke
  • Capillary index score (CIS)
  • Intra-arterial treatment
  • Patient selection
  • Revascularization
  • Stroke outcome
  • The 50% barrier

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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