Hohenstatt Sophia, Vollherbst Dominik F, Miralbés Salvador, Naravetla Bharath, Spiotta Alejandro, Loehr Christian, Martínez-Galdámez Mario, McTaggart Ryan, Defreyne Luc, Vega Pedro, Zaidat Osama O, Jenkins Paul, Vinci Sergio Lucio, Liebeskind David S, Gupta Rishi, Möhlenbruch Markus A, Tessitore Agostino
From the Department of Neuroradiology (S.H., D.F.V., M.A.M.), University Hospital Heidelberg, Heidelberg, Germany.
Neuroradiology (S.M.), Hospital Son Espases, Mallorca, Spain.
AJNR Am J Neuroradiol. 2025 Jun 3;46(6):1130-1136. doi: 10.3174/ajnr.A8613.
Mechanical thrombectomy (MT) is effective for acute ischemic stroke, yet its indication in mild stroke remains unclear. This study evaluates the effectiveness and safety of MT in patients with low NIHSS scores and assesses the impact of different MT strategies on procedural success and clinical outcomes.
Data from the ASSIST Registry were analyzed. We categorized patients with large-vessel occlusion of the anterior circulation into mild (NIHSS ≤5) and moderate-severe (NIHSS >5) stroke groups. Baseline characteristics, procedural parameters, angiographic and imaging outcomes, clinical outcomes, and safety end points were compared. Within the mild stroke subgroup, outcomes were compared between different MT techniques.
Among 1360 patients with large-vessel occlusion, 122 had minor ischemic strokes (9%). Patients with mild stroke had high rates of excellent functional outcomes (mRS 0-1) at 90 days (77.1%) and functional independence (mRS 0-2) (85.7%). Procedural success rates were similar between NIHSS groups, while safety outcomes, except mortality, were comparable. No statistically significant differences were observed in treatment techniques within the mild stroke subgroup. Significant predictors of early neurologic deterioration (END) in patients with mild stroke were the total number of passes (OR, 1.49; 95% CI, 1.01-2.19; = .04) and total procedural time (OR, 1.02; 95% CI, 1.01-1.04; = .01). Patients with END were more likely to have an unfavorable functional outcome (mRS 3-6) at 90 days (89% versus 6%, < .001).
MT is effective and safe in patients with mild stroke. Procedural success did not vary among MT techniques in mild stroke. The total number of passes predict END, which suggests a causal pathway that requires further exploration.
机械取栓术（MT）对急性缺血性卒中有效，但其在轻度卒中中的适应证仍不明确。本研究评估MT在低美国国立卫生研究院卒中量表（NIHSS）评分患者中的有效性和安全性，并评估不同MT策略对手术成功率和临床结局的影响。
分析来自ASSIST注册研究的数据。我们将前循环大血管闭塞患者分为轻度（NIHSS≤5）和中重度（NIHSS>5）卒中组。比较基线特征、手术参数、血管造影和影像学结局、临床结局及安全性终点。在轻度卒中亚组中，比较不同MT技术的结局。
在1360例大血管闭塞患者中，122例为轻度缺血性卒中（9%）。轻度卒中患者在90天时功能结局良好（改良Rankin量表[mRS] 0 - 1）的比例较高（77.1%），且功能独立（mRS 0 - 2）的比例为（85.7%）。NIHSS组之间的手术成功率相似，而除死亡率外的安全性结局具有可比性。在轻度卒中亚组内，治疗技术方面未观察到统计学显著差异。轻度卒中患者早期神经功能恶化（END）的显著预测因素为通过次数（比值比[OR]，1.49；95%置信区间[CI]，1.01 - 2.19；P = 0.04）和总手术时间（OR，1.02；95% CI，1.01 - 1.04；P = 0.01）。发生END的患者在90天时更有可能出现不良功能结局（mRS 3 - 6）（89%对6%，P < 0.001）。
MT对轻度卒中患者有效且安全。轻度卒中中MT技术之间的手术成功率无差异。通过次数可预测END，这提示了一条需要进一步探索的因果途径。
