Outcomes after endovascular mechanical thrombectomy for low compared to high National Institutes of Health Stroke Scale (NIHSS): A multicenter study.
Document Type
Article
Abstract
OBJECTIVE: The role of endovascular mechanical thrombectomy (MT) in patients presenting with "minor" stroke is uncertain. We aimed to compare outcomes after MT for ischemic stroke patients presenting with National Institutes of Health Stroke Scale (NIHSS) 5 and - within the low NIHSS cohort - identify predictors of a favorable outcome, mortality, and symptomatic intracranial hemorrhage (ICH).
METHODS: We retrospectively analyzed a prospectively maintained, international, multicenter database.
RESULTS: The study cohort comprised a total of 7568 patients from 29 centers. NIHSS was low (5 in 6964 (92%). Patients with low NIHSS were younger (67 + 14.8 versus 69.6 + 14.7 years, p < 0.001), more likely to have diabetes (31.5% versus 26.9%, p = 0.016), and less likely to have atrial fibrillation (26.6% versus 37.6%, p < 0.001) compared to those with higher NIHSS. Radiographic outcomes (TICI > 2B 84.6% and 84.3%, p = 0.412) and complication rates (8.1% and 7.2%, p = 0.463) were similar between the low and high NIHSS groups, respectively. Clinical outcomes at every follow up interval, including NIHSS at 24 h and discharge, and mRS at discharge and 90 days, were better in the low NIHSS group, however patients in the low NIHSS group experienced a relative decline in NIHSS from admit to discharge. Mortality was lower in the low NIHSS group (10.4% versus 24.5%, p < 0.001).
CONCLUSIONS: Relative to patients with high NIHSS, MT is safe and effective for stroke patients with low NIHSS, and it is reasonable to offer it to appropriately selected patients presenting with minor stroke symptoms. Our findings justify efforts towards a randomized trial comparing MT versus medical management for patients with low NIHSS.
Medical Subject Headings
United States; Humans; Retrospective Studies; Thrombectomy; Treatment Outcome; Stroke; National Institutes of Health (U.S.); Brain Ischemia; Endovascular Procedures
Publication Date
2-1-2023
Publication Title
Clinical neurology and neurosurgery
ISSN
1872-6968
Volume
225
First Page
107592
Last Page
107592
PubMed ID
36657358
Digital Object Identifier (DOI)
10.1016/j.clineuro.2023.107592
Recommended Citation
Abecassis, Isaac Josh; Almallouhi, Eyad; Chalhoub, Reda; Kasab, Sami Al; Bass, Eric; Ding, Dale; Saini, Vasu; Burks, Joshua D; Maier, Ilko L; Psychogios, Marios-Nikos; Liman, Jan; Alawieh, Ali; Wolfe, Stacey; Arthur, Adam S; Shaban, Amir; Dumont, Travis; Kan, Peter; Kim, Joon-Tae; De Leacy, Reade; Osbun, Joshua; Rai, Ansaar; Jabbour, Pascal; Grossberg, Jonathan A; Park, Min S; Crosa, Roberto; Mascitelli, Justin; Levitt, Michael R; Polifka, Adam; Casagrande, Walter; Yoshimura, Shinichi; Matouk, Charles; Williamson, Richard; Gory, Benjamin; Mokin, Maxim; Fragata, Isabel; Romano, Daniele G; Chowdry, Shakeel; Moss, Mark; Behme, Daniel; Limaye, Kaustubh; Spiotta, Alejandro M; and Starke, Robert M, "Outcomes after endovascular mechanical thrombectomy for low compared to high National Institutes of Health Stroke Scale (NIHSS): A multicenter study." (2023). Neurosurgery. 2109.
https://scholar.barrowneuro.org/neurosurgery/2109