Abstract
Introduction:Strategy for the acute management of minor ischemic stroke (IS) with large vessel occlusion (LVO) is under debate, especially the benefits of mechanical thrombectomy. The frequency of minor IS with LVO among overall patients is not well established. This study aimed to assess the proportion of minor IS and to depict characteristics of patients according to the presence of LVO in a comprehensive population-based setting.Methods:Patients with acute IS were prospectively identified among residents of Dijon, France, using a population-based registry (2013–2017). All arterial imaging exams were reviewed to assess arterial occlusion. Minor stroke was defined as that with a National Institutes of Health Stroke Scale (NIHSS) score of <6. Proportion of patients with LVO was estimated in the minor IS population. The clinical presentation of patients was compared according to the presence of an LVO.Results:Nine hundred seventy-one patients were registered, including 582 (59.9%) patients with a minor IS. Of these patients, 23 (4.0%) had a LVO. Patients with minor IS and LVO had more severe presentation [median 3 (IQR 2–5) vs. 2 (IQR 1–3), p = 0.001] with decreased consciousness (13.0 vs. 1.6%, p<0.001) and cortical signs (56.5 vs. 30.8%, p = 0.009), especially aphasia (34.8 vs. 15.4%, p = 0.013) and altered item level of consciousness (LOC) questions (26.1 vs. 11.6%, p = 0.037). In multivariable analyses, only NIHSS score (OR = 1.45 per point; 95% CI: 1.11–1.91, p = 0.007) was associated with proximal LVO in patients with minor IS.Conclusion:Large vessel occlusion (LVO) in minor stroke is non-exceptional, and our findings highlight the need for emergency arterial imaging in any patients suspected of acute stroke, including those with minor symptoms because of the absence of obvious predictors of proximal LVO.
Highlights
Strategy for the acute management of minor ischemic stroke (IS) with large vessel occlusion (LVO) is under debate, especially the benefits of mechanical thrombectomy
IS etiology differed between patients with or without minor-stroke, with a greater proportion of cardioembolic IS observed among patients with non-minor stroke (45 vs. 24.6%)
Past myocardial infarction (OR = 0.62; 95% CI:0.40−0.97, p = 0.035), mild cognitive impairment (MCI) (OR = 0.58; 95% CI:0.36–0.95, p = 0.029), small vessel disease etiology (OR = 3.69; 95% CI: 1.76–7.74, p = 0.001), undetermined etiology (OR = 2.49; 95% CI: 1.52–4.06, p < 0.001), and IS with multiple causes (OR = 5.50; 95% CI: 1.97–15.34, p = 0.001) were associated with minor stroke
Summary
Strategy for the acute management of minor ischemic stroke (IS) with large vessel occlusion (LVO) is under debate, especially the benefits of mechanical thrombectomy. In some cases, patients with minor symptoms at initial presentation of IS, defined as a National Institute of Health Stroke Scale (NIHSS) score of < 5, may have a large vessel occlusion (LVO). In such a situation, a strong collateral circulation is usually associated with a relatively preserved cerebral blood perfusion, but there is a subsequent risk of early neurological deterioration when the adaptive process is overtaken if patients are not recanalized [1]. The frequency of minor IS with LVO among overall patients is not well known
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