This study seeks to investigate the capillary index score (CIS) to further improve patient selection of endovascular treatment (EVT) in acute ischemic stroke (AIS).
The hypothesis or idea being tested:
Patients with favorable CIS who are successfully revascularized with EVT can have successful outcomes with an extended time window for treatment.
This study is trying to look at how the well-being of the patient following treatment is influenced by peripheral blood supply (collateral flow) to the area lacking primary blood flow due to the clot. Treatment of AIS includes EVT and medical treatment. EVT is typically not offered to patients after 6 hours of the onset of symptoms. The current study is based on the belief that patients can be successfully treated with the EVT up to 8 hours, as long as they have good peripheral blood flow (collateral flow) to the area of tissue blocked of the primary blood supply.
The study will evaluate the ability of the capillar index score (CIS) to identify patients who can be successfully treated with EVT. The CIS quantifies blood supply to the ischemic area from peripheral vessels (collateral flow) based on diagnostic cerebral angiogram. Patients are graded on a scale from 0-3, with 0 and 1 considered a poor CIS (pCIS) and 2 and 3 considered a favorable CIS (fCIS). All patients will be treated with EVT and medical treatment consistent with national guidelines.
The primary endpoint is the clinical outcome at 90 days between fCIS group versus pCIS group. The secondary endpoint is the influence of successful revascularization on outcomes for patients with fCIS or pCIS.
- Endovascular Treatment (EVT) Procedure
Other Names: Intra-arterial Treatment (IAT) Intervention Desc: EVT is an endovascular procedure in which a catheter is inserted into an artery and directed to the site of the blocked blood vessel in the brain. The clot is removed using a mechanical device with or without an injection of tPA directly at the site of the clot. ARM 1: Kind: Experimental Label: Favorable CIS Description: Patients with a favorable CIS (fCIS) will receive endovascular treatment (EVT) and medical treatment consistent with national guidelines. ARM 2: Kind: Experimental Label: Poor CIS Description: Patients with a poor CIS (pCIS) will receive endovascular treatment (EVT) and medical treatment consistent with national guidelines.
- Observation: Cohort
- Perspective: Prospective
- Sampling: Non-Probability Sample
The population for the study will consist of patients from multiple stroke centers across the United States, who have anterior circulation acute ischemic stroke due to blockage of the intracranial internal carotid artery or middle cerebral artery (M1) within 8 hours of onset of symptoms.
|Type||Measure||Time Frame||Safety Issue|
|Primary||Modified Rankin score (mRS) between favorable CIS group versus poor CIS group.||90 days||No|
|Secondary||Complication rate between favorable CIS group versus poor CIS group||1 day - 1 week||No|
|Secondary||The influence of successful revascularization on outcomes for patients with favorable CIS group or poor CIS group||90 days||No|
|Secondary||Modified Rankin score (mRS) between favorable CIS with good revascularization versus poor CIS with good revascularization.||90 days||No|