Abstract
Background and purposeIf patients presenting with large vessel occlusions (LVO) and mild symptoms should be treated with endvoascular treatment (EVT) remains unclear. Aims of this study were (1) assessing the safety and technical efficacy of EVT in patients with NIHSS < 8 as opposed to a comparison group of patients presenting with NIHSS ≥ 8 and (2) evaluation of the clinical effect of reperfusion in patients with NIHSS < 8.MethodsPatients included into the retrospective multicenter BEYOND-SWIFT registry (NCT03496064) were analyzed. Clinical effect of achieving successful reperfusion (defined as modified Thrombolysis in Cerebral Infarction grade 2b/3) in patients presenting with NIHSS < 8 (N = 193) was evaluated using multivariable logistic regression analyses (displayed as adjusted Odds Ratios, aOR and 95% confidence intervals, 95%-CI). Primary outcome was excellent functional outcome (modified Rankin Scale, mRS 0–1) at day 90. Safety and efficacy of mechanical thrombectomy in patients with NIHSS < 8 was compared to patients presenting with NIHSS ≥ 8 (N = 1423).ResultsAmong patients with NIHSS < 8 (N = 193, 77/193, 39.9% receiving pre-interventional IV-tPA), successful reperfusion was significantly related to mRS 0–1 (aOR 3.217, 95%-CI 1.174–8.816) and reduced the chances of non-hemorrhagic neurological worsening (aOR 0.194, 95%-CI 0.050–0.756) after adjusting for prespecified confounders. In interaction analyses, the relative merits of achieving successful reperfusion were mostly comparable between patients presenting with NIHSS < 8 and NIHSS ≥ 8 as evidenced by non-significantly different aOR. Interventional safety and efficacy metrics were similar between patients with NIHSS < 8 and NIHSS ≥ 8.ConclusionsAchieving successful reperfusion is beneficial in patients with persisting LVO presenting with NIHSS < 8 and reduces the risk of non-hemorrhagic neurological worsening.
Highlights
In a considerable proportion of stroke patients presenting with mild neurological symptoms, a proximal anterior circulation large-vessel occlusion (LVO) is identified as the underlying cause [1, 2]
Rates of non-hemorrhagic neurological worsening tended to be higher in patients with NIHSS < 8 as compared to patients with NIHSS ≥ 8 (13.8% vs 9.0%, P = 0.076)
Better outcomes were observed in patients with successful reperfusion as indicated by significantly higher rates of modified Rankin Scale (mRS) 0–1 (49.7% vs 21.9%, P = 0.006, Fig. 2b) and mRS 0–2 (71.4% vs 37.5%, P < 0.001)
Summary
In a considerable proportion of stroke patients presenting with mild neurological symptoms, a proximal anterior circulation large-vessel occlusion (LVO) is identified as the underlying cause [1, 2]. In most patients with proximal LVO and low NIHSS scores on admission, indications for endovascular treatment (EVT) are not covered by current evidence derived from the large pivotal thrombectomy trials [3, 4]. In these patients, a well-developed collateral network presumably ensures sufficient blood flow to the territory distal to the occlusion site and neuronal functioning is largely maintained [5]. Clinical effect of achieving successful reperfusion (defined as modified Thrombolysis in Cerebral Infarction grade 2b/3) in patients presenting with NIHSS < 8 (N = 193) was evaluated using multivariable logistic regression analyses (displayed as adjusted Odds Ratios, aOR and 95% confidence intervals, 95%-CI). Conclusions Achieving successful reperfusion is beneficial in patients with persisting LVO presenting with NIHSS < 8 and reduces the risk of non-hemorrhagic neurological worsening
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