Department of Neurological Surgery University of Louisville, Louisville, KY, USA.
Department of Neurological Surgery Medical University of South Carolina, Charleston, SC, USA.
Clin Neurol Neurosurg. 2023 Feb;225:107592. doi: 10.1016/j.clineuro.2023.107592. Epub 2023 Jan 13.
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).
We retrospectively analyzed a prospectively maintained, international, multicenter database.
The study cohort comprised a total of 7568 patients from 29 centers. NIHSS was low (<5) in 604 patients (8%), and > 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).
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.
血管内机械血栓切除术（MT）在出现“轻度”卒中的患者中的作用尚不确定。我们旨在比较美国国立卫生研究院卒中量表（NIHSS）为 5 分和 NIHSS 低分组内的缺血性卒中患者接受 MT 后的结局，并确定预后良好、死亡率和症状性颅内出血（ICH）的预测因素。
我们回顾性分析了一个前瞻性维护的国际多中心数据库。
研究队列包括来自 29 个中心的总共 7568 名患者。604 名患者（8%）的 NIHSS 较低（<5），6964 名患者（92%）的 NIHSS 较高。NIHSS 较低的患者更年轻（67±14.8 岁比 69.6±14.7 岁，p<0.001），更有可能患有糖尿病（31.5%比 26.9%，p=0.016），且不太可能患有心房颤动（26.6%比 37.6%，p<0.001）。与 NIHSS 较高的患者相比，影像学结局（TICI>2B 分别为 84.6%和 84.3%，p=0.412）和并发症发生率（8.1%和 7.2%，p=0.463）在低 NIHSS 组和高 NIHSS 组之间相似。在每个随访间隔的临床结局，包括 24 小时和出院时的 NIHSS，以及出院和 90 天时的 mRS，低 NIHSS 组均更好，但低 NIHSS 组的 NIHSS 从入院到出院相对下降。低 NIHSS 组的死亡率较低（10.4%比 24.5%，p<0.001）。
与 NIHSS 较高的患者相比，MT 对 NIHSS 较低的卒中患者是安全有效的，为适当选择的出现轻微卒中症状的患者提供 MT 是合理的。我们的发现证明了为 NIHSS 较低的患者进行 MT 与药物治疗的随机试验是合理的。
