Presenter of 3 Presentations
LARGE VESSEL OCCLUSION OF THE ANTERIOR CIRCULATION AND LOW NIHSS, WHAT SHOULD WE DO? A MULTICENTER PROPENSITY SCORE MATCHING ANALYSIS.
Abstract
Background and Aims
The benefit of mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) and baseline mild neurological symptoms (NIHSS score ≤ 5) remains unclear. The purpose of this study was to evaluate the effectiveness of MT in this subgroup of patients.
Methods
The databases of 9 high-volume Italian stroke centers were retrospectively screened for patients with LVO in the anterior circulation and a baseline NIHSS score ≤ 5 that received either immediate MT or best medical management (BMM) with the possibility of rescue MT upon neurological worsening. Primary outcome measure was a mRS score 0-1 at 90 days. Propensity score matching (PSM) analysis was used to estimate the treatment effect of immediate MT compared to BMM/rescue MT.
Results
Two hundred and seventy-two patients received immediate MT (MT group). The BMM/rescue MT group included 41 patients. The primary outcome was achieved in 78.6 % (n=246) of overall patients, with a higher proportion in the MT group (80.5% vs. 65.9%, p=0.03) in unadjusted analysis. After PSM, patients in the MT group had a 19.5% higher chance of excellent outcome at 90 days compared to the BMM/Rescue MT group with a similar risk of death from any cause.
Conclusions
Our experience is in favor of a potential benefit of MT also in patients with LVO and a NIHSS score ≤ 5 at the time of groin puncture. Nonetheless, this issue waits for a clear-cut recommendation in a dedicated clinical trial.
ENDOVASCULAR TREATMENT IN PATIENTS WITH BASILAR ARTERY OCCLUSION AND LOW NIHSS
Abstract
Background and Aims
Endovascular successful vessel recanalization in posterior circulation large vessels occlusions is considered crucial although the evidence of clinical usefulness, compared to anterior circulation, is not still determined, especially in patients with low NIHSS. The aim of this study was to evaluate the outcome in patients with NIHSS <10, and analyze predictors of good and worse outcome in these patients.
Methods
The databases of 10 high-volume European stroke centers were retrospectively screened for patients with acute basilar artery occlusion or a single dominant vertebral artery occlusion (“functional” BAO) who had 3-month mRS. Clinical, procedural and radiologic data were evaluated. According to guidelines, before thrombectomy, intravenous recombinant tissue plasminogen activator was administered to eligible patients. Primary outcome measure was a mRS score 0-1 at 90 days. Uni- and multivariate analysis were performed in two subgroups of patient (with NIHSS < or >10).
Results
Baseline NIHSS was < 10 in 63 out of 191 patients (33%). In this subgroup, favorable outcome (90 days mRS0-2) was obtained in 37/63 patients (58,7%). Multivariate analysis demonstrated that a higher pc-ASPECTS (adj OR 4.75; 95% CI 1.33-16.94; p=0.02) and higher Delta NIHSS (adj OR 2.06; 95% CI 1.16-3.65; p=0.01) were predictors of better outcome. Female gender (adj OR 0.04; 95% CI 0-0.84; p=0.04) and combined technique (adj OR 0.001; 95% CI 0-0.81; p=0.04) were predictors of worse outcome.
Conclusions
Favorable outcome was obtained in 37/63 patients (58,7%) with NIHSS <10. Higher pc-ASPECTS and Delta NIHSS were predictors of better outcome. Female gender and combined technique were predictors of worse outcome.
MECHANICAL THROMBECTOMY IN ACUTE ISCHEMIC STROKE DUE TO M2 OCCLUSION AND LOW BASELINE NIHSS SCORE: A MULTICENTER RETROSPECTIVE ANALYSIS.
Abstract
Background and Aims
The benefit of mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) due to M2 occlusion and baseline mild neurological symptoms (NIHSS score ≤ 5) remains unclear. The purpose of this study was to evaluate the effectiveness of MT in this subgroup of patients.
Methods
The databases of 9 high-volume Italian stroke centers were retrospectively screened for patients with M2 segment occlusion and a baseline NIHSS score ≤ 5 that received either immediate MT or best medical management (BMM) with the possibility of rescue MT upon neurological worsening. Primary outcome measure was a mRS score 0-1 at 90 days. Propensity score matching (PSM) analysis was used to estimate the treatment effect of immediate MT compared to BMM/rescue MT.
Results
One hundred and twenty-one patients received immediate MT (MT group). The BMM/rescue MT group included 27 patients. The primary outcome was achieved in 78.3 % (n=108) of overall patients, with a higher proportion in the MT group (76.8% vs. 55%). In the MT group there were five deaths, while in the BMM/rescue MT there was one death.
Conclusions
Our experience is in favor of a potential benefit regarding 3 months mRS of MT in patients with M2 occlusion and a NIHSS score ≤ 5 at the time of groin puncture. Nonetheless, this issue waits for a clear-cut recommendation in a dedicated clinical trial.