Abstract 26: Treatment Choice and Discharge Outcomes in Patients Presenting With Large Vessel Occlusion and Low National Institutes of Health Stroke Scale

Abstract

Introduction: Since 2015, endovascular thrombectomy (EVT) has been widely accepted as the standard of care for patients presenting proximal anterior circulation large vessel occlusion (LVO). However, patient selection for EVT remains uncertain in patients presenting with LVO and low NIHSS. Methods: Retrospective data from 37 hospitals within a large multi-hospital system stroke registry were analyzed and included patients age 18 or over, discharged between January 2016 and May 2020, with an admission NIHSS < 6, and who had a LVO visualized in the internal carotid artery or middle cerebral artery. Patients treated with EVT (with or without IV alteplase), IV alteplase alone, or best medical management (BMM) without IV alteplase or EVT were compared with regard to modified Rankin scale (mRS) at hospital discharge and hospital length of stay (LOS). Pearson’s chi-square square test and Mann-Whitney U test were conducted. Results: Discharge mRS analysis included 742 patients, 211 (28.4%) treated with EVT (with or without IV alteplase), 107 (14.4%) treated with IV alteplase alone, and 424 (57.2%) treated with BMM. A greater proportion of patients treated with IV alteplase alone (71.0%) had no or slight disability (mRS 0-2) compared to EVT (with or without IV alteplase) (51.7%), or BMM (52.6%) (p=.001). Analyses of LOS included 1,037 patients, 298 (28.7%) treated with EVT (with or without IV alteplase), 157 (15.1%) treated with IV alteplase alone, and 582 (56.1%) treated with BMM. Patients treated with IV alteplase alone had significantly shorter LOS (2.0 days, [Interquartile Range:3.0]) compared to EVT (with or without IV alteplase) (3.0 days [4.0]), or BMM (3.0 days [4.0]) (p<.001). Conclusion: Amongst this cohort of patients presenting with anterior circulation LVO and low NIHSS, better discharge outcomes were seen in patients treated with IV alteplase alone, compared to EVT (with or without IV alteplase) or BMM. The best treatment for this patient population remains unclear, and further research is needed.