Capillary Index Score in the Interventional Management of Stroke trials I and II.
OBJECTIVE
The Capillary Index Score (CIS) is a simple angiography-based scale for assessing viable tissue in the ischemic territory. We retrospectively applied it to Interventional Management of Stroke (IMS) trials I and II to evaluate the predictive value for good outcomes.


METHODS
CIS was calculated from pretreatment diagnostic cerebral angiograms blinded to outcome. IMS I and II diagnostic cerebral angiogram images of sufficient quality were reviewed and CIS calculated for treated subjects with internal carotid artery or M1 occlusion. CIS scoring (0-3) was dichotomized into favorable (f CIS; 2 or 3) and poor (p CIS; 0 or 1). Modified thrombolysis in cerebral infarction score 2b or 3 was considered good revascularization. CIS and modified thrombolysis in cerebral infarction scores were compared with good outcome, defined as modified Rankin Scale score≤2 at 90 days.


RESULTS
Twenty-eight of 161 subjects met the inclusion criteria. Thirteen (46%) had f CIS. Good clinical outcome was significantly different between the 2 CIS groups (62% for f CIS versus 7% for p CIS; P=0.004). Good reperfusion correlated to good outcome (P=0.04). No significant differences in time to intravenous or intra-arterial treatment were identified between f CIS and p CIS groups (P>0.25).


CONCLUSIONS
A f CIS was found in ≈50% of subjects and was a virtual prerequisite for good outcome in this study subgroup of IMS I and II. We call this the 50% barrier.
From the Division of Neurointerventional Surgery, CNS Healthcare Foundation, Akron, OH (F.A.-A., G.Z.M., Z.A.-A.); Department of Radiology (T.A.T.) and Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati Neuroscience Institute, OH; Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.J.C.); and Department of Neurology (J.M.G.) and Department of Research (J.J.E.), Akron General Medical Center, OH. firasalali@aol.com.
Firas
F
Al-Ali
From the Division of Neurointerventional Surgery, CNS Healthcare Foundation, Akron, OH (F.A.-A., G.Z.M., Z.A.-A.); Department of Radiology (T.A.T.) and Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati Neuroscience Institute, OH; Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.J.C.); and Department of Neurology (J.M.G.) and Department of Research (J.J.E.), Akron General Medical Center, OH.
Thomas A
TA
Tomsick
From the Division of Neurointerventional Surgery, CNS Healthcare Foundation, Akron, OH (F.A.-A., G.Z.M., Z.A.-A.); Department of Radiology (T.A.T.) and Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati Neuroscience Institute, OH; Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.J.C.); and Department of Neurology (J.M.G.) and Department of Research (J.J.E.), Akron General Medical Center, OH.
John J
JJ
Connors
From the Division of Neurointerventional Surgery, CNS Healthcare Foundation, Akron, OH (F.A.-A., G.Z.M., Z.A.-A.); Department of Radiology (T.A.T.) and Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati Neuroscience Institute, OH; Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.J.C.); and Department of Neurology (J.M.G.) and Department of Research (J.J.E.), Akron General Medical Center, OH.
James M
JM
Gebel
From the Division of Neurointerventional Surgery, CNS Healthcare Foundation, Akron, OH (F.A.-A., G.Z.M., Z.A.-A.); Department of Radiology (T.A.T.) and Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati Neuroscience Institute, OH; Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.J.C.); and Department of Neurology (J.M.G.) and Department of Research (J.J.E.), Akron General Medical Center, OH.
John J
JJ
Elias
From the Division of Neurointerventional Surgery, CNS Healthcare Foundation, Akron, OH (F.A.-A., G.Z.M., Z.A.-A.); Department of Radiology (T.A.T.) and Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati Neuroscience Institute, OH; Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.J.C.); and Department of Neurology (J.M.G.) and Department of Research (J.J.E.), Akron General Medical Center, OH.
Georges Z
GZ
Markarian
From the Division of Neurointerventional Surgery, CNS Healthcare Foundation, Akron, OH (F.A.-A., G.Z.M., Z.A.-A.); Department of Radiology (T.A.T.) and Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati Neuroscience Institute, OH; Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.J.C.); and Department of Neurology (J.M.G.) and Department of Research (J.J.E.), Akron General Medical Center, OH.
Zein
Z
Al-Ali
From the Division of Neurointerventional Surgery, CNS Healthcare Foundation, Akron, OH (F.A.-A., G.Z.M., Z.A.-A.); Department of Radiology (T.A.T.) and Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati Neuroscience Institute, OH; Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.J.C.); and Department of Neurology (J.M.G.) and Department of Research (J.J.E.), Akron General Medical Center, OH.
Joseph P
JP
Broderick
D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D002196:Capillaries / Q000000981:diagnostic imaging*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D002533:Cerebral Angiography / Q000706:statistics & numerical data*; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D002986:Clinical Trials as Topic; D019468:Disease Management; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016037:Single-Blind Method; D020521:Stroke / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D015912:Thrombolytic Therapy / Q000379:methods*
D005343:Fibrinolytic Agents
collateral circulation; diagnostic imaging; diagnostic techniques, neurological; stroke, acute