Mechanical Thrombectomy for Acute Stroke Due to Large-Vessel Occlusion Presenting With Mild Symptoms

Abstract

Purpose: To evaluate the safety and efficacy of mechanical thrombectomy (MT) for acute stroke due to large vessel occlusion (LVO), presenting with mild symptoms.Methods: A prospective cohort study of patients with mild ischemic stroke and LVO was conducted. Patients were divided into two groups: MT group or best medical management (MM) group. Propensity score matching (PSM) was conducted to reduce the confounding bias between the groups. The primary outcome was functional independence at 90 days. The safety outcome was symptomatic intracranial hemorrhage (sICH). Univariate and multivariate logistic regression analyses were used to identify the independent factors associated with outcomes.Results: Among the 105 included patients, 43 were in the MT group and 62 in the MM group. Forty-three pairs of patients were generated after PSM. There were no significant differences in sICH rates between two groups (p = 1.000). The MT group had a higher proportion of independent outcomes (83.7% MT vs. 67.4% MM; OR 2.483; 95% CI 0.886–6.959; p = 0.079) and excellent outcomes (76.7% MT vs. 51.2% MM; OR 3.150; 95% CI 1.247–7.954; p = 0.013) compared to the MM group, especially in patients with stroke of the anterior circulation (p < 0.05). Multivariate logistic regression analysis showed that small infarct core volume (p = 0.015) and MT treatment (p = 0.013) were independently associated with excellent outcomes.Conclusions: Our results suggest that MT in stroke patients, presenting with mild symptoms, due to acute LVO in the anterior circulation may be associated with satisfactory clinical outcomes.Clinical Trial Registration:ClinicalTrials.gov, identifier: NCT04526756.

Mechanical thrombectomy for AIS from large vessel occlusion – current trends and future perspectives

“…To the best of our knowledge, no RCTs have been conducted on this matter, and observational research has produced contradictory findings. Our findings corroborated the findings of the retrospective research in patients with LVO and moderate symptoms (NIHSS 0–5), thrombectomy was linked to better clinical outcomes than medicinal treatment 27 . Additionally, a 2018 meta-analysis found that thrombectomy had positive results for LVO stroke patients with little or mild symptoms (NIHSS 8) 28 .…”

“…An elevated risk of sICH may be linked to several MT passes. Since the invention of the thrombectomy procedure about 10 years ago, patients in this research have seen fewer problems and deaths 27 . Overall, primary concerns with MT in patients with mild stroke remain revolve around sICH and associated sequelae.…”