Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Department of Neurological Surgery, University of Miami MILLER School of Medicine, Miami Beach, Florida, USA.
J Neurointerv Surg. 2021 Feb;13(2):146-151. doi: 10.1136/neurintsurg-2020-016583. Epub 2020 Oct 7.
While the landmark 2015 stroke trials demonstrated that endovascular therapy (EVT) was superior to medical management for the treatment of acute ischemic stroke due to large vessel occlusion, the efficacy of EVT for patients presenting with a low NIHSS score remains undetermined. We conducted a review of the EVT low National Institutes of Health Stroke Scale (NIHSS) stroke literature, identifying 24 quantitative and six qualitative publications. Details of study designs and outcome were extracted and critically discussed.All identified qualitative studies were retrospective. There was significant study design heterogeneity, with 18 unique study designs between the 24 identified quantitative manuscripts. Study investigations included low NIHSS EVT feasibility (n=6), EVT versus best medical management (BMM; n=10), EVT versus intravenous therapy (IVT, n=3), and low NIHSS score versus high NIHSS score (n=3). From single-arm EVT feasibility studies, the reported ranges of modified Thrombolysis in Cerebral Infarction and symptomatic intracranial hemorrhage were 78-97% and 0-10%, respectively. The EVT versus BMM literature had heterogeneous results with 40% reporting benefit with EVT and 60% reporting neutral findings. None of the studies comparing EVT with IVT reported a difference between the two revascularization therapies. The four identified meta-analyses had incongruent inclusion criteria and conflicting results. Two randomized trials are currently investigating EVT in patients with a low NIHSS score. Selected meta-analyses do suggest a potential benefit of EVT over BMM; however, current and future randomized clinical trials will better elucidate the efficacy of EVT in this patient population.
虽然 2015 年的里程碑式中风试验表明，血管内治疗 (EVT) 优于药物治疗，可用于治疗大血管闭塞引起的急性缺血性中风，但 EVT 对 NIHSS 评分较低的患者的疗效仍未确定。我们对 EVT 治疗低 NIHSS 中风的文献进行了回顾，确定了 24 篇定量研究和 6 篇定性研究。提取并批判性地讨论了研究设计和结果的详细信息。所有确定的定性研究均为回顾性研究。研究设计存在显著的异质性，24 篇定量研究中有 18 种独特的研究设计。研究调查包括低 NIHSS EVT 的可行性 (n=6)、EVT 与最佳药物治疗 (BMM; n=10)、EVT 与静脉内治疗 (IVT, n=3) 以及低 NIHSS 评分与高 NIHSS 评分 (n=3)。从单臂 EVT 可行性研究中，报告的改良溶栓治疗脑梗死和症状性颅内出血的范围分别为 78-97%和 0-10%。EVT 与 BMM 的文献结果存在异质性，40%的研究报告 EVT 有益，60%的研究报告中性结果。比较 EVT 与 IVT 的研究均未报告两种再通治疗之间存在差异。四项确定的荟萃分析的纳入标准不一致，结果相互矛盾。两项随机试验目前正在研究低 NIHSS 评分患者的 EVT。一些荟萃分析确实表明 EVT 优于 BMM 的潜在益处；然而，目前和未来的随机临床试验将更好地阐明 EVT 在这一患者人群中的疗效。
