Abstract
BackgroundMechanical thrombectomy has been proven as a standard care for moderate to severe ischemic stroke with anterior large vessel occlusion (LVO); however, whether it is equally effective in mild ischemic stroke (MIS) is controversial.MethodsIn this retrospective study, a total of 177 Chinese patients presenting with MIS (NIHSS ≤8) and LVO between January 2014 and September 2017 from seven comprehensive stroke centers were identified. Odds of good outcome with endovascular thrombectomy versus medical treatment were obtained by logistic regression analysis and propensity-score matching method, and a meta-analysis pooled results from six studies (n = 733).ResultsGood outcome (mRS: 0–1) was 58.2% (46/79) in the thrombectomy and 46.9% (46/98) in the medical group, which showed no statistical significance before adjustment (P = 0.13; OR = 1.57, 95% CI: 0.86 to 2.86). The adjusted ORs of thrombectomy versus medical group were 3.23 (95% CI, 1.35 to 7.73; P = 0.008) by multivariable logistic analysis, 2.78 (1.12 to 6.89; P = 0.02) by propensity score matching analysis, and 3.20 (1.22 to 8.37; P = 0.01) by propensity score matching analysis with additional adjustments, respectively. Thrombectomy treatment did not result in excessive mortality or symptomatic intracranial hemorrhage after adjustments. The meta-analysis did not confirm the associations between good outcome and endovascular treatment.ConclusionsThe current study indicates that endovascular thrombectomy is associated with good functional outcome in MIS patients with LVO, and without additional risk of symptomatic intracranial hemorrhage and mortality. Although the meta-analysis failed to demonstrate its superiority compared to medical treatment, randomized clinical trials are needed.
Highlights
Mechanical thrombectomy has been proven as a standard care for moderate to severe ischemic stroke with anterior large vessel occlusion (LVO); whether it is effective in mild ischemic stroke (MIS) is controversial
Hospital of the People’s Liberation Army) between January 2014 and August 2017, and all these patients initially presented with mild neurological deficit during 24 h, which defined as National institute of health stroke scale (NIHSS) ≤8, and was diagnosed as having LVO, including Intracranial carotid artery (ICA), M1 or M2 segment of Middle cerebral artery (MCA), and ACA on computed tomography angiography (CTA) or Magnetic resonance angiography (MRA)
Baseline characteristics A total of 79 patients treated with mechanical endovascular thrombectomy (MET) and 98 patients having medical treatment were identified in this study
Summary
Mechanical thrombectomy has been proven as a standard care for moderate to severe ischemic stroke with anterior large vessel occlusion (LVO); whether it is effective in mild ischemic stroke (MIS) is controversial. Since the publication of six randomized control trials, mechanical endovascular thrombectomy (MET) has become a standard therapy for patients with moderate to severe ischemic stroke and large vessel occlusion (LVO) in the proximal anterior circulation [1,2,3,4,5,6]. The efficacy and safety of MET for MIS remains controversial. We retrospectively analyzed the data of MIS patients treated with MET or medical therapy from our center, and combined the previously published data through a meta-analysis to obtain more reliable conclusions. All radiological data and clinical medical records of the subjects were sent to the core laboratory in our hospital, and were reviewed in a blinded fashion by two neurologists (Y-T Guo and S Zhang) with advice of a third experienced neurologist (W-J Zi) in cases of disagreement
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