Abstract WMP86: Mechanical Thrombectomy Frequency and Outcomes in Acute Ischemic Stroke With Mild Deficits in the Unites States

Abstract

Background: More than half of patients with acute ischemic stroke have minor neurological deficits; however, the frequency and outcomes of reperfusion therapy in regular practice hasn't been well-delineated. Methods: Analysis of US National Inpatient Sample of hospitalizations with acute ischemic stroke and mild deficits (National Institutes of Health Stroke Scale [NIHSS] score 0-5) from October 1, 2016 to December 31, 2020. Patient and hospital-level characteristics associated with use and outcome of reperfusion therapies were analyzed. Primary outcomes included excellent discharge disposition (discharge to home without assistance); poor discharge disposition (discharge to facility or death) and in-hospital mortality. Results: Among 1,013,055 acute ischemic stroke admissions with recorded NIHSS during the 4-year study period, 601,645 (59.4%) had mild strokes (46.6% women; median age, 69 [interquartile range (IR), 59-79] years; median NIHSS score of 2 [IR, 1-3]). Among 70,765 hospitalizations with MT and documented NIHSS, mild deficits accounted for 8,900 (12.6%) of MT procedures (47% women; median age, 67 [IR, 57-77] years; median NIHSS score of 3 [IR, 2-4]). There was a gradual increase in the proportion of MTs performed among mild strokes during study period (10% to 13.5%, p<0.01). Favorable discharge outcome occurred in 65.8% of all mild strokes and in 56.9% of strokes with mild deficits following MT. In multivariable analysis among stroke patients with minor deficits with thrombectomy, favorable outcome was associated with younger age (OR, 0.96 [95% CI, 0.95-0.97], P<0.001), male sex (OR, 0.77 [95% CI, 0.62-0.95], P<0.001), lower NIHSS score (OR, 0.85 [95% CI, 0.80-0.90], P<0.001), history of atrial fibrillation (OR, 1.27 [95% CI, 1.01-1.60], P<0.001), and absence of diabetes (OR, 0.77 [95% CI, 0.60-0.98], P<0.001). Conclusions: In conclusion, we observed a recent trend of gradual increase in the use of MT in mild strokes in US. Favorable discharge outcomes were achieved in a significant proportion of mild strokes following MT. Further research and clinical trials should aim to refine patient selection criteria and treatment protocols to optimize the use of MT in mild strokes.