Acute ischemic stroke treatment, part 1: patient selection "the 50% barrier and the capillary index score".
Acute ischemic stroke treatment, part 1: patient selection "the 50% barrier and the capillary index score".
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DOI：
10.3389/fneur.2015.00083
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发表时间：
2015
影响因子：
3.4
通讯作者：
Faber JE
中科院分区：
文献类型：
--
作者：
Al-Ali F;Elias JJ;Filipkowski DE;Faber JE
急性缺血性卒中的动脉内治疗（IAT）目前的策略集中在最大限度地减少从发作到血运重建的时间和最大限度地血运重建。采用这一战略尚未提高成功率。然而，侧支供血可能在缺血期间维持存活脑组织方面起重要作用。根据我们之前的工作，我们认为只有大约50%的患者在遗传上倾向于在治疗后有足够的侧支循环以获得良好的结果，我们称之为50%屏障。毛细血管指数评分（CIS）已被开发为一种工具，用于识别具有足够侧支血供的患者，以在治疗前维持组织活力。CIS（f CIS）良好的患者可能能够在任意时间窗外使用IAT获得良好结局。CIS被并入到所提出的患者治疗算法中。对于无失语症的大卒中患者，应在非增强头部CT后进行CT血管造影（CTA）。对于没有卒中样体征或由于大面积不可逆缺血导致的可见结构变化体征的患者，CTA可以帮助确认血管闭塞和位置。CIS可以从诊断性脑血管造影中获得，并向归类为f CIS的患者提供IAT。
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 (f CIS) 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, with IAT offered to patients categorized as f CIS.
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