E-Poster Discussions

Abstract

Background and aims: It remains unclear whether patients presenting with large vessel occlusion strokes and mild symptoms benefit from mechanical thrombectomy (MT). The purpose of the present study was to compare outcomes in acute ischemic stroke patients with intracranial vessel occlusions and minor stroke symptoms (NIHSS 5 or lower) treated with MTwith those who treated with intravenous thrombolysis (IVT) alone. Methods: In a prospective observational study at Oslo University Hospital, we assessed the outcome in patients admitted with minor stroke (NIHSS 5 or lower), premorbid modified Rankin Scale 0-2, middle cerebral-M1/M2, intracranial carotid, anterior cerebral or basilar artery occlusions. Groups receiving MT and IVT only were compared. Clinical outcome with improvement of NIHSS from baseline to 24 hours and modified Rankin Scale at 3 months were compared as well as MT safety. Results: Among 323 consecutive patients treated with EVT in 2017-18 48 (15.1%) had mild strokes with NIHSS 5 or lower at admission. All patients were assessed with perfusion imaging before MT. Median NIHSS was 1 after 24 hours and median mRS after three months was 0 (range 0-3) in patients with NIHSS 5 or lower who were treated with MT. In the group of consecutive patients with NIHSS 5 or lower who were treated with IVT, median NIHSS after 24 hours was 1 (range 0-5) and median mRS 0 (range 0-3). Conclusion: Thrombectomy in selected patients with low NIHSS is safe and can increase the chance of excellent clinical outcome after 3 months. Larger prospective studies are needed. Trial registration number: N/A

Blood–Brain Barrier Disruption and Hemorrhagic Transformation in Acute Ischemic Stroke: Systematic Review and Meta-Analysis

“…HT extent may range from single-blood petechiae with few clinical consequences to symptomatic HT with a high rate of mortality and disability. While most studies reported the association between BBB disruption and HT, only few studies investigated the relation with unfavorable outcomes such as symptomatic intracranial hemorrhage (sICH) (20,26,34); therefore, this association, although potentially useful for clinicians, is still unclear and needs to be further clarified.…”

“…However, we extracted from the studies mean age of patients, stroke severity, site of occlusion, and time from onset to enrolment, and we observed that particularly in CT studies, such variables were similar, whereas in MR studies, there was more difference. It should be noted that only 4/14 CT studies (15,23,24,26) and 10/16 MR studies (27-30, 32, 34-36, 42) reported univariate associations between BBB disruption and HT and were included in the meta-analysis; consequently, the ORs were found to represent a gross estimate of the relation between BBB and HT and should be interpreted with caution. Many CT and MR studies reported only adjusted associations; however, the sets of covariates largely differed across studies; thus, pooling-adjusted ORs were potentially inappropriate.…”

“…Five studies were found as having a low risk of bias (15,21,23,24,26), seven a high risk (13, 17-20, 22, 25), and two an unclear risk (14, 16) (Supplemental Table 1). The general clinical characteristics of the included studies evaluating BBB with CT are summarized in the Supplemental Table 2.…”

“…Univariate ORs were present in four studies (N = 794)-two prospective (24,26) and two retrospective (15,23)-other studies provided only multivariate or did not provide ORs. In the metaanalysis of the four aforementioned studies, BBB disruption was associated with HT (OR = 3.42; 95%CI = 1.62-7.23).…”