Acute ischemic stroke treatment, part 1: Patient SelectionThe 50% Barrier and the Capillary Index Score
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...
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doaj-d64b4fc44e0c45129d8b702bdc3463382020-11-24T22:16:28ZengFrontiers Media S.A.Frontiers in Neurology1664-22952015-04-01610.3389/fneur.2015.00083133681Acute ischemic stroke treatment, part 1: Patient SelectionThe 50% Barrier and the Capillary Index ScoreFiras eAl-Ali0Firas eAl-Ali1John J. Elias2Danielle Elizabeth Filipkowski3Ramón eGilberto González4James E. Faber5Akron General Medical CenterSummit Neurovascular SpecialistsAkron General Medical CenterAkron General Medical CenterMassachusetts General HospitalUniversity of North Carolina School of MedicineThe 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.http://journal.frontiersin.org/Journal/10.3389/fneur.2015.00083/fullPatient SelectionAcute ischemic strokeRevascularizationthe 50% barrierintra-arterial treatmentcapillary index score (CIS) |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Firas eAl-Ali Firas eAl-Ali John J. Elias Danielle Elizabeth Filipkowski Ramón eGilberto González James E. Faber |
spellingShingle |
Firas eAl-Ali Firas eAl-Ali John J. Elias Danielle Elizabeth Filipkowski Ramón eGilberto González James E. Faber Acute ischemic stroke treatment, part 1: Patient SelectionThe 50% Barrier and the Capillary Index Score Frontiers in Neurology Patient Selection Acute ischemic stroke Revascularization the 50% barrier intra-arterial treatment capillary index score (CIS) |
author_facet |
Firas eAl-Ali Firas eAl-Ali John J. Elias Danielle Elizabeth Filipkowski Ramón eGilberto González James E. Faber |
author_sort |
Firas eAl-Ali |
title |
Acute ischemic stroke treatment, part 1: Patient SelectionThe 50% Barrier and the Capillary Index Score |
title_short |
Acute ischemic stroke treatment, part 1: Patient SelectionThe 50% Barrier and the Capillary Index Score |
title_full |
Acute ischemic stroke treatment, part 1: Patient SelectionThe 50% Barrier and the Capillary Index Score |
title_fullStr |
Acute ischemic stroke treatment, part 1: Patient SelectionThe 50% Barrier and the Capillary Index Score |
title_full_unstemmed |
Acute ischemic stroke treatment, part 1: Patient SelectionThe 50% Barrier and the Capillary Index Score |
title_sort |
acute ischemic stroke treatment, part 1: patient selectionthe 50% barrier and the capillary index score |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Neurology |
issn |
1664-2295 |
publishDate |
2015-04-01 |
description |
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. |
topic |
Patient Selection Acute ischemic stroke Revascularization the 50% barrier intra-arterial treatment capillary index score (CIS) |
url |
http://journal.frontiersin.org/Journal/10.3389/fneur.2015.00083/full |
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