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MINOR STROKES WITH LARGE VESSEL OCCLUSION: A MATCHED ANALYSIS FROM THE GERMAN STROKE REGISTRY-ENDOVASCULAR TREATMENT(GSR-ET) AND THE SAFE IMPLEMENTATION OF THROMBOLYSIS IN STROKE REGISTRY (SITS)
Abstract
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 LVO-minor stroke patients treated with intravenous thrombolysis(IVT) plus/minus mechanical thrombectomy(MT).
Methods
GSR-ET and SITS-registry patients enrolled between 06/2015 and 12/2019 were analyzed. Minor stroke patients due to LVO were compared using propensity score matching (PSM). Primary outcomes were the safety, technical and clinical efficacy of IVT plus/minus MT including the technical angiographic outcome parameters (successful reperfusion using the modified Thrombolysis In Cerebral Infarction (mTICI) score of 2b-3) and good functional outcome at 3-months follow-up (modified Rankin Scale (mRS) of 0-2).
Results
Among 6635 GSR-patients, a total of 676 (9.6%) presented with minor strokes. Among these, 272GSR-ET-patients – all IVT-treated (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% female, pmRS 0 (0-0), NIHSS 4 (2-5)). Successful reperfusion in GSR-ET-patients was achieved in 81.6%. Good functional outcome (67.3% versus 69.5%, p=0.795), mortality (5.1% versus 6.6%, p=0.207) and intracranial hemorrhage (12.5% versus 8.8%, p=0.308) were comparable. After PSM for 624 GSR-ET-patients (IVT-rate 56.7%) and 624 SITS-patients (IVT-rate 100%) 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 stroke patients. There is an urgent need for randomized controlled trials in this stroke field, including imaging parameters.