Abstract
While mechanical thrombectomy for large-vessel occlusions is now an evidence-based treatment, its efficacy and safety in minor stroke syndromes (NIHSS ≤ 5) is not proved. We identified, in our prospective data base, 378 patients with minor strokes in the anterior circulation; 54 (14.2%) of these had proved large-vessel occlusions. Eight of 54 (14.8%) were immediately treated with mechanical thrombectomy, 6/54 (11.1%) after early neurologic deterioration, and the rest were treated with standard thrombolysis only. Rates of successful recanalization were similar between the 2 mechanical thrombectomy groups (75% versus 100%). Rates of excellent outcome (modified Rankin Scale 0-1) were higher in patients with immediate thrombectomy (75%) compared with patients with delayed thrombectomy (33.3%) and thrombolysis only (55%). No symptomatic intracranial hemorrhage occurred in either group. These descriptive data are encouraging, and further analysis of large registries or even randomized controlled trials in this patient subgroup should be performed.
Highlights
Patients with minor stroke syndrome (MSS) with occlusions of the internal carotid artery and the M1 and M2 segments of the middle cerebral artery were divided into 3 groups: patients who received mechanical thrombectomy immediately (MT-I) or mechanical thrombectomy after early neurologic deterioration (MT-END) or intravenous thrombolysis only (IV)
Rates of excellent outcome were highest in patients with MT-I (75%) compared with the other groups (MT-END, 33.3%; IV, 55%)
We found that patients with MSS and largevessel occlusions had, if immediately treated with MT, slightly better outcomes compared with patients with MSS who were only thrombolyzed (75% [MT-I] versus 66% for all our patients with MSS or 55% for those with MSS with large-vessel occlusions)
Summary
We present a retrospective and descriptive analysis of a case series derived from a large prospective stroke data base, with particular focus on mechanical thrombectomy performed immediately after presentation with MSS or as rescue therapy after clinical deterioration.
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