Relative Influence of Capillary Index Score, Revascularization, and Time on Stroke Outcomes From the Interventional Management of Stroke III Trial

Abstract

Background and purpose: 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.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00359424.

Keywords: acute ischemic stroke; capillary index score; collateral; outcome; revascularization.

Conflict of interest statement

Conflict of Interest/Disclosures

Dr. Liebeskind has served as a consultant for Covidien and Stryker. Furthermore, the University of California holds a patent on retriever devices for stroke at the time of this work. The University of Cincinnati Department of Neurology receives financial support from Genetech for Dr. Broderick’s research roles (Executive Committee of A Study of the Efficacy and Safety of Activase [Alteplase] in Patients With Mild Stroke Trial). Dr. Broderick has also received materials and supplies from Genentech (study medication for Interventional Management of Stroke III), EKOS Corp, Cordis Neurovascular and Concentric Inc. (study catheter devices for Interventional Management of Stroke III), and support for travel from Boehringer Ingelheim. Dr. Tomsick served as an interventional primary investigator on the National Institutes of Health National Institute of Neurological Disorders and Stroke grant U01NS052220 with his salary from NIH. No other authors have any conflicts of interest related to this study.

© 2015 American Heart Association, Inc.