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Thrombectomy versus medical management for large vessel occlusion strokes with minimal symptoms: an analysis from STOPStroke and GESTOR cohorts.

Abstract：

INTRODUCTION:It remains unclear whether patients presenting with large vessel occlusion strokes and mild symptoms benefit from thrombectomy. OBJECTIVE:To compare outcomes of endovascular therapy versus medical management in patients with large vessel occlusion strokes and National Institute of Health Stroke Scale (NIHSS) score ≤5. METHODS:This was a retrospective analysis combining two large prospectively collected datasets including patients with (1) admission NIHSS score ≤5, (2) premorbid modified Rankin Scale (mRS) score 0-2, and (3) middle cerebral-M1/M2, intracranial carotid, anterior cerebral or basilar artery occlusions. Groups receiving (1) endovascular treatment and (2) medical management were compared. The primary and secondary outcome measures were NIHSS shift (discharge NIHSS minus admission NIHSS) and the rates of mRS 0-2 at discharge and 3-6 months, respectively. Univariate, multivariate, and matched analyses were performed. RESULTS:Eighty-eight patients received medical management and 30 thrombectomy. Multivariable analysis indicated thrombectomy was the only predictor of favorable NIHSS shift (β -3.7, 95% CI -6.0 to -1.5, p=0.02), as well as independence at discharge (β -21.995% CI -41.4to -20.8, p<0.01) and 3-6-month follow-up (β -21.1, 95% CI -39.1 to -19.7, p<0.01). A matched analysis (based on age, baseline NIHSS and intravenous tissue plasminogen activator use) produced 26 pairs. Endovascular therapy was statistically associated with lower NIHSS at discharge (p=0.04), favorable NIHSS shift (p=0.03), and increased independence rates at discharge (p=0.03) and 3-6-month follow-up (p=0.04). CONCLUSION:In patients presenting with minimal stroke symptoms (NIHSS score ≤5) and large vessel occlusion strokes, mechanical thrombectomy appears to be associated with a favorable shift of NIHSS at discharge, as well as higher rates of independence at discharge and long-term follow-up. Confirmatory prospective studies are warranted.

journal_name

J Neurointerv Surg

journal_title

Journal of neurointerventional surgery

authors

Haussen DC,Lima FO,Bouslama M,Grossberg JA,Silva GS,Lev MH,Furie K,Koroshetz W,Frankel MR,Nogueira RG

doi

10.1136/neurintsurg-2017-013243

subject

Has Abstract

pub_date

2018-04-01 00:00:00

pages

325-329

issue

eissn

1759-8478

issn

1759-8486

pii

neurintsurg-2017-013243

journal_volume

pub_type

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Thrombectomy versus medical management for large vessel occlusion strokes with minimal symptoms: an analysis from STOPStroke and GESTOR cohorts.