Group Name

Lars Kellert on behalf of the GSR investigators.

Niaz Ahmed on behalf of the SITS investigators.

Background And Aims

Treatment of large vessel occlusion (LVO) in patients presenting with mild neurological deficits (minor strokes with NIHSS ≤5) is still a matter of debate. The main purpose of this study was to compare the outcome of these patients treated with intravenous thrombolysis (IVT) plus/minus mechanical thrombectomy(MT).

Methods

Patients enrolled between 06/2015 and 12/2019 in the German Stroke Registry-Endovascular Treatment(GSR-ET) and the Safe Implementation of Thrombolysis in Stroke (SITS)-registry were analyzed. Minor LVO-stroke patients were compared using propensity score matching (PSM). Primary outcomes were the safety, technical and clinical efficacy of IVT plus/minus MT including rate of successful reperfusion using the modified Thrombolysis In Cerebral Infarction (mTICI) score (2b-3) and good functional outcome at 3-months follow-up (modified Rankin Scale (mRS) of 0-2).

Results

676(9.6%) out of the GSR-ET presented with minor strokes. Among these, 272 GSR-ET-patients – all treated with IVT (age 68.6±14.0 years, 43.4% female, premorbid mRS(pmRS) 0 (0-0), NIHSS 4 (2-5)) were compared to 272 SITS-patients (69.4±13.7, 43.4% females, pmRS 0 (0-0), NIHSS 4 (2-5)). Successful reperfusion in GSR-ET-patients was achieved in 81.6%. Good functional outcome (67.3% versus69.5%, p=0.795), mortality (5.1% versus6.6%, p=0.207) and rate of intracranial hemorrhage (ICH) (12.5% versus8.8%, p=0.308) were comparable between both groups. After PSM for 624 GSR-ET-patients (IVT-rate 56.7%) and 624 SITS-patients independent predictors for good outcome were age, pmRS, NIHSS, IVT-treatment and occurrence of ICH.

Conclusions

Our study demonstrates similar effectiveness of IVT alone compared to MT plus/minus IVT in minor LVO-stroke patients. There is an urgent need for randomized controlled trials in this stroke field.

Trial Registration Number

Not applicable