Abstract W P112: Natural History and Outcomes of Ischemic Stroke Patients with Mild Presenting Symptoms and Large Vessel Occlusion

Abstract

Introduction: Large vessel occlusion (LVO) is thought to be an independent predictor of clinical outcome in acute ischemic stroke (AIS). Despite various available treatment modalities, optimal therapy for LVO patients presenting with mild symptoms is not known. These patients remain a significant challenge in clinical practice. Methods: Retrospective chart review of AIS patients admitted between January 2010 and August 2012 at a large tertiary care center. Inclusion criteria: symptom onset within 8 hours, LVO as cause of symptoms, initial NIH stroke scale (NIHSS) < 8. Patients with bilateral lesions, distal small vessel involvement or single vertebral artery disease were excluded. Tandem lesions were included. Patient demographics, administered therapies and short term clinical outcomes were analyzed. Results: A total of 51 patients (56.9% male; mean age 66.4±14.5) fulfilled our strict criteria for inclusion. MCA involvement was seen in 31 (60.8%), ICA 13 (25.5%), basilar 3 (5.9%) and tandem ICA-MCA in 4 (7.8%). A total of 15 (29.4%) received acute therapy with IV t-PA and/or endovascular intervention (TX); both were used only in 6 (11.8%). Follow-up at 30 days was available in 64.7% of patients: 58.3% with TX and 80% without. Mean NIHSS remained relatively stable showing 4.3±2.1 on admission, and 2.6±3.4 on discharge (NS), with 75.8% of patients having same or better NIHSS on follow-up. There was a significant difference in functional outcome: mRS≤2 was present in 98% of patients on admission, but only in 63.6% at follow-up. If extended the mRS range, 90.9% of patients had mRS≤3 on follow-up. Only 33.3% at follow-up had same or better mRS than on admission. Results were consistent, irrespective of receiving acute therapy. Conclusion: Acute LVO with mild presenting symptoms remains a difficult therapeutic challenge. Our data shows that despite stable gross clinical examination (by NIHSS) on follow-up, a large proportion of patients experience mild to moderately worse functional outcome, irrespective of receiving acute therapy. Our study limitations include retrospective analysis and suboptimal patient follow-up, especially in untreated patient population. We believe that a prospective, larger cohort is warranted to find optimal treatment approach.