Introduction: Increased reperfusion rates following Intra-arterial treatment for acute ischemic stroke (IAT-AIS) do not always translate into clinical improvement We undertook this study to evaluate whether a readily discernible angiographic measure could identify some of these patients.
Methods: A blinded retrospective review of pre-intervention DCA from patients in the Borgess registry (BR), IMS I and II trials, and the DEFUSE 2 Study was performed. CIS was calculated in those patients with a good-quality baseline DCA. Patients were scored from 0-3, 0 being poor and 3 excellent collateral staining in the vascular territory at risk. CIS of 0 was compared to 3-month clinical. TIMI 2, 3 (BR). or TICI 2b, 3 (IMS I, II, DEFUSE) was considered excellent revascularization (ER). mRS 0-2 at 3 months was considered good outcome.
Results: the results are shown in table (1). Of the 101 patients, 17 had CIS =0. None improved following treatment, independent of the final revascularization status. The subgroup analysis of IMS III will also be presented. The percentage of CIS=0 patients was very similar in all of these studies, which may indicate an underlying physiological condition.
n CIS 0 ER mRS 0-2
Borgess 25 3 (12%) 2 0
IMS I, II 28 6 (21.4%) 2 0
DEFUSE II 48 8 (16.6%) 2 0
101 17 (16.8%) 6 (35.3%) 0
(Table 1)
Conclusions: Our analysis suggests that patients with a CIS=0 will not benefit from (IAT-AIS), independent of final recanalization. CIS 0 should be considered as a potential exclusion criterion in (IAT-AIS). This implies that if we exclude these patients from previous and future trials the merit of (AIS-IAT) over Intra-venous or placebo arms may become readily apparent.
Patient Care: by offering intra arterial treatment to appropriate patients with acute ischemic stroke, without relaying on arbitrary time window
Learning Objectives: improve patient's selection for intra-arterial ischemic stroke treatment
References: The capillary index score: rethinking the acute ischemic stroke treatment algorithm. Results from the Borgess Medical Center Acute Ischemic Stroke Registry
Firas Al-Ali, Anne Jefferson, et al. J NeuroIntervent Surg 2013;5:139-143 doi:10.1136/neurintsurg-2011-010146