Effectiveness and safety of EVT in patients with acute LVO and low NIHSS

Abstract

Background and purposeThere is much uncertainty in endovascular treatment (EVT) decisions in patients with acute large vessel occlusion (LVO) and mild neurological deficits.MethodsFrom a prospective, nationwide stroke registry, all patients with LVO and baseline NIHSS <6 presenting within 24 h from the time last known well (LKW) were included. Early neurological deterioration (END) developed before EVT was prospectively collected as an increasing total NIHSS score ≥2 or any worsening of the NIHSS consciousness or motor subscores during hospitalization not related to EVT. Significant hemorrhage was defined as PH2 hemorrhagic transformation or hemorrhage at a remote site. The modified Rankin Scale (mRS) was prospectively collected at 3 months.ResultsAmong 1,083 patients, 149 (14%) patients received EVT after a median of 5.9 [3.6–12.3] h after LKW. In propensity score-matched analyses, EVT was not associated with mRS 0-1 (matched OR 0.99 [0.63–1.54]) but increased the risk of a significant hemorrhage (matched OR, 4.51 [1.59–12.80]). Extraneous END occurred in 207 (19%) patients after a median of 24.5 h [IQR, 13.5–41.9 h] after LKW (incidence rate, 1.41 [95% CI, 1.23–1.62] per 100 person-hours). END unrelated to EVT showed a tendency to modify the effectiveness of EVT (P-for-interaction, 0.08), which decreased the odds of having mRS 0–1 in mild LVO patients without END (adjusted OR, 0.63 [0.40–0.99]).ConclusionsThe use of EVT in patients with acute LVO and low NIHSS scores may require the assessment of individual risks of early deterioration, hemorrhagic complications and expected benefit.

Endovascular treatment versus medical management for mild stroke with acute anterior circulation large vessel occlusion: a meta-analysis

“…After full-text reading, 20 articles were excluded for the following reasons: (1) the medical treatment group was not relevant, (2) the mild stroke was not relevant, (3) patients with posterior circulation occlusion were included, and (4) the outcomes of the EVT and medical treatment groups were missing. Finally, 14 articles12 18–20 27–36 were found to be eligible, with 1819 and 2516 patients treated with EVT and medical treatment, respectively (figure 1).…”

“…Table 1 shows the details of the design and baseline characteristics of each included study. Furthermore, PS-based methods adjusted analysis was reported in 10 studies,18–20 28 29 31–35 whose main characteristics are summarized in online supplemental table 2).…”

Biomarker of early neurological deterioration in minor stroke and proximal large vessel occlusion: A pilot study

“…On the one hand, most patients with LVO strokes and mild symptoms have good clinical outcomes; on the other hand, among patients with early neurological deterioration (END), 77% were dead or dependent at 3 months ( 3 ). The safety and effectiveness of endovascular therapy have been confirmed by a large number of literature ( 4 – 8 ). Therefore, endovascular therapy should not be given to all patients for LVO, nor should it be stopped because of mild stroke.…”

Medical Management Versus Endovascular Treatment for Large-Vessel Occlusion Anterior Circulation Stroke With Low NIHSS

“…[36][37][38][39] Conversely, in 7 studies rescue EVT cases were added in the interventional arm and these studies were considered PP design. 12,[30][31][32][33][34][35] Among those 7 studies, only 2 presented data on patients that required rescue EVT, resulting in a pooled proportion of 2% of patients undergoing rescue EVT within the interventional arm (Figure S14). 31,32…”