E-069 Validation of a New Modified Capillary Index Score Angiographic Real Time Assessment of Dead vs Salvable Tissue. J Neurointerv Surg 2014 Jul;6 Suppl 1:A71
Date
07/30/2014Pubmed ID
25064990Abstract
BACKGROUND: The original capillary index score publication only included patients that had full digital subtraction angiograms (DSA) before stroke intervention. This CIS was a single center publication with no external validation. Many centers do not perform a full DSA to assess all collaterals before intervention.
HYPOTHESIS: A modified capillary index score (mCIS) using only the ICA injection can predict outcome in MCA occlusions (only MCA occlusions included).
OBJECTIVE: Validate the utility and use of a modified capillary index score (mCIS) to assess outcomes and improvement in acute stroke patients.
METHODS: mCIS was assessed on all consecutive patients with an MCA occlusion with complete database information. NIHSS, recanalization (mTICI), and mRS before and after treatment were assessed. mCIS of 2-3 was considered favorable as per original publication. Correlation between favorable CIS, NIHSS improvement, and mRS (0-3 good) were assessed.
RESULTS: 33 patients with MCA occlusion with complete data sets where assessed. 63.6% (21/33) had a favorable mCIS (2-3) and 36.4% had a poor mCIS(0-1). Recanalization of TICI 2b or greater was achieved in 42.9% (9/21) of patients with favorable mCIS and 58.3% (7/12) of patients with poor mCIS. Of those with favorable mCIS 28.6% (6/21) had a good mRS of ≤3 at discharge vs those with poor mCIS while those with a poor mCIS 33.3% had a good mRS at discharge. However, mortality was lower in favorable mCIS vs. poor mCIS (9.5 vs. 33.35, p = 0.09).
CONCLUSIONS: A modified CIS is did not predict the functional outcome but may be predictor of mortality. Small sample size, lack of long-term follow up, or the lower rate of recanalization of those with favorable mCIS could have contributed to the negative outcome. A prospective or larger study with long term follow up is needed for validation.
REFERENCES: Al-Ali F, Jefferson A, Barrow T, et al. The capillary index score: rethinking the acute ischemic stroke treatment algorithm. Results from the Borgess Medical Center Acute Ischemic Stroke Registry. J Neurointerv Surg. 2013;5(2):139-143. doi:10.1136/neurintsurg-2011-010146 Capillary Index Score, Baseline Characteristics and Outcomes Favorable mCIS Unfavorable mCIS P Value Baseline NIHSS 14 + /-6.9 18.3 + /-3.9 0.051 Age 64.3 + /-16.6 68.8 + /-4.9 0.453 Good Recanalization (2b-3) 42.9% (9/21) 58.3% (7/12) 0.391 NIHSS at Discharge 10.8 + /-7.5 15 + /-2.5 0.099 NIHSS at Discharge in TICI 2b and higher 5.8 + /-4.2 13.4 + /-13.7 0.067 Mortality 2/21 (9.5%) 4/12 (33.33%) 0.093 Good Outcome (mRS < = 3) 28.6% (6/21) 33.33% (4/12) 0.775 Good Outcome in TICI2b or higher 12 mRS < = 3) 5/9 (55.6%) 4/7 (57.1%) 0.0949 DISCLOSURES: M. Teleb: None. M. Noufal: None. A. Sattar: None. W. Wazni: None. M. Issa: None. K. Asif: None. A. Gheith: None. A. Castonguay: None. O. Zaidat: 2; C; Penumbra, Stryker, Covidie. 3; C; Penumbra, Stryker, Covidien.