Abstract TP17: Outcomes of Large Vessel Occlusion Patients in a Multi-Hospital System With Nihss<6 Treated With Endovascular Thrombectomy vs Medical Management

Abstract

With the publication of the 2018 updated acute stroke management guidelines, the American Stroke Association very publically proclaimed the safety and efficacy of endovascular thrombectomy (EVT) for the treatment of acute ischemic stroke due to proximal large vessel occlusion in individuals with NIHSS >=6. The appropriate management of individuals who present with less severe large vessel occlusion (NIHSS < 6) is less certain. Anecdotally, many individuals with low presenting NIHSS who are treated with EVT do well; conversely, about 20% of medically managed stroke patients deteriorate. We retrospectively analyzed stroke data obtained from a multi-hospital system for large vessel occlusion patients with admission NIHSS < 6 discharged between January 2014 and May 2018, excluding those <18 years of age and those with time of onset or last known well that is unknown or >24hours. Outcomes included length of stay and percentage of patients who died in-hospital or were discharged to hospice, had a discharge other than to home or rehab, and had a discharge mRS ≥2. A total of 144 patients were included with 45% (n=65) treated by EVT. Those who were treated were younger, had higher admit NIHSS, and were more likely to be transfers. There were no significant differences in in-hospital mortality or discharge to hospice, discharge other than to home or rehab, or discharge mRS ≥2. EVT-treated patients had longer lengths of stay after adjusting for age, admission NIHSS, and LKW-to-door time (+36% (CI: 8, 64); p=0.012). Of EVT-treated patients, 3.1% (n=2) had a sICH and 90.3% (n=56 out of 62) had a successful reperfusion. When using medical judgment to evaluate the benefit of treating low NIHSS stroke, Interventionists are likely to select individuals who are more symptomatic or have been referred by an outside facility, a trend that achieved significance within our sample. Although the length of stay for individuals treated with EVT was on average one day longer than those who were medically managed, there was no significant difference in complications or outcomes between the two groups. Our findings are consistent with similar analyses and help argue for the safety of EVT for select individuals with presenting NIHSS < 6.