title: Relative Influence of Capillary Index Score, Revascularization, and Time on Stroke Outcomes From the Interventional Management of Stroke III Trial.
abstract: OBJECTIVE
  Until recently, acute ischemic stroke (AIS) trials have failed to show a benefit of endovascular therapy compared with standard therapy, leading some authors to recommend decreasing the time from ictus to revascularization to improve outcomes. We hypothesize that improving patient selection using the capillary index score (CIS) may also be a useful strategy.
  
  
  METHODS
  CIS was calculated, blinded to outcome, from pretreatment diagnostic cerebral angiograms for 78 subjects in the Interventional Management of Stroke III database with internal carotid artery and middle cerebral artery trunk occlusion. The CIS was dichotomized into favorable (fCIS=2 or 3) and poor (pCIS=0 or 1). Outcomes were categorized based on the modified Rankin Scale score at 90 days (0-2 considered a good outcome). Modified thrombolysis in cerebral infarction score 2b or 3 was considered good revascularization. Multivariable logistic regression was performed to relate CIS, time from ictus to revascularization, modified thrombolysis in cerebral infarction score, and National Institue of Health Stroke Scale score to good outcomes.
  
  
  RESULTS
  Only CIS and modified thrombolysis in cerebral infarction scores were correlated with good outcomes (P<0.01). Patients with fCIS and good revascularization achieved 71% modified Rankin Scale≤2, compared with 13% for patients with pCIS and good revascularization.
  
  
  CONCLUSIONS
  In this subset of patients from the Interventional Management of Stroke III Trial, CIS and modified thrombolysis in cerebral infarction were strong predictors of outcome after endovascular reperfusion. Using the CIS to improve patient selection could be a powerful strategy to improve rate of good outcomes in endovascular therapy. A randomized trial is needed.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00359424.
authors.affiliation: From the Departments of Neuro-Interventional Surgery (F.A.-A.) and Research (J.J.E.), Akron General Medical Center, OH; Department of Radiology, University of Cincinnati Academic Health Center, OH (T.A.T.); Neurovascular Imaging Research Core & UCLA Department of Neurology, Los Angeles, CA (D.S.L.); and Department of Neurology, University of Cincinnati Academic Health Center, OH (J.P.B.). falali@snsphysicians.com.
authors.forename: Firas
authors.initials: F
authors.lastname: Al-Ali
authors.affiliation: From the Departments of Neuro-Interventional Surgery (F.A.-A.) and Research (J.J.E.), Akron General Medical Center, OH; Department of Radiology, University of Cincinnati Academic Health Center, OH (T.A.T.); Neurovascular Imaging Research Core & UCLA Department of Neurology, Los Angeles, CA (D.S.L.); and Department of Neurology, University of Cincinnati Academic Health Center, OH (J.P.B.).
authors.forename: John J
authors.initials: JJ
authors.lastname: Elias
authors.affiliation: From the Departments of Neuro-Interventional Surgery (F.A.-A.) and Research (J.J.E.), Akron General Medical Center, OH; Department of Radiology, University of Cincinnati Academic Health Center, OH (T.A.T.); Neurovascular Imaging Research Core & UCLA Department of Neurology, Los Angeles, CA (D.S.L.); and Department of Neurology, University of Cincinnati Academic Health Center, OH (J.P.B.).
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Tomsick
authors.affiliation: From the Departments of Neuro-Interventional Surgery (F.A.-A.) and Research (J.J.E.), Akron General Medical Center, OH; Department of Radiology, University of Cincinnati Academic Health Center, OH (T.A.T.); Neurovascular Imaging Research Core & UCLA Department of Neurology, Los Angeles, CA (D.S.L.); and Department of Neurology, University of Cincinnati Academic Health Center, OH (J.P.B.).
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
authors.affiliation: From the Departments of Neuro-Interventional Surgery (F.A.-A.) and Research (J.J.E.), Akron General Medical Center, OH; Department of Radiology, University of Cincinnati Academic Health Center, OH (T.A.T.); Neurovascular Imaging Research Core & UCLA Department of Neurology, Los Angeles, CA (D.S.L.); and Department of Neurology, University of Cincinnati Academic Health Center, OH (J.P.B.).
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Broderick
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002533:Cerebral Angiography; D002548:Cerebral Revascularization; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D015912:Thrombolytic Therapy
keywords: acute ischemic stroke; capillary index score; collateral; outcome; revascularization