Mechanical thrombectomy in patients with M1 occlusion and NIHSS score ≤5: a single-centre experience

Bhogal, Pervinder; Bücke, Philipp; Ganslandt, Oliver; Bäzner, Hansjörg; Henkes, Hans; Pérez, Marta Aguilar

doi:10.1136/svn-2016-000052

Cited by 34 publications

(30 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another German single-center report including 41 patients with M1 occlusions and NIHSS 0 to 5 described 4.8% sICH and a 75% rate of good outcome after 3 months. 21 If minor stroke patients deteriorate and rescue MT is performed later (68% >8 hours from onset), MT (n=28) seemed to be associated with better outcome (adjusted OR: 10.9; 95% CI ) compared with those without MT (n=181). 22 However, rescue MT may be inferior to IMT in these patients.…”

Section: Discussionmentioning

confidence: 93%

Mechanical Thrombectomy in Patients With Milder Strokes and Large Vessel Occlusions

Nagel

Bouslama

Krause

et al. 2018

Stroke

102

View full text Add to dashboard Cite

Background and Purpose-We aimed to describe the safety and efficacy of immediate mechanical thrombectomy (MT) in patients with large vessel occlusions and low National Institutes of Health Stroke Scale (NIHSS) versus best medical management. Methods-Patients from prospectively collected databases of 6 international comprehensive stroke centers with large vessel occlusions (distal intracranial internal carotid, middle cerebral artery-M1 and M2 segments, or basilar artery with or without tandem occlusions) and NIHSS 0 to 5 were identified and divided into 2 groups for analysis: immediate MT or initial best medical management which included rescue MT after neurological deterioration (best medical management-MT). Uni-and multivariate analyses and patient-level matching for age, baseline NIHSS, and occlusion site were performed to compare baseline and outcome variables across the 2 groups. The primary outcome was defined as good outcome (modified Rankin Scale score, 0-2) at day 90. Safety outcome was symptomatic intracranial hemorrhage as defined by the ECASS (European Cooperative Acute Stroke Study) II and mortality at day 90. Results-Compared with best medical management-MT (n=220), patients with immediate MT (n=80) were younger (65.3±13.5 versus 69.5±14.1; P=0.021), had more often atrial fibrillation (44.8% versus 28.2%; P=0.012), higher baseline NIHSS (4, 0-5 versus 3, 0-5; P=0.005), higher Alberta Stroke Program Early CT Score (10, 7-10 versus 10, 5-10; P=0.023), more middle cerebral artery-M1, and less middle cerebral artery-M2 (41.3% versus 21.9% and 28.8% versus 49.3%; P=0.016) occlusions. The adjusted odds ratio for good outcome was 3.1 (95% CI, 1.4-6.9) favoring immediate MT. In the matched analysis, there was a 14.4% absolute difference in good outcome (84.4% versus 70.1%; P=0.03) at day 90 favoring immediate MT. There were no safety concerns. Conclusions-Our retrospective, pilot analysis suggests that immediate thrombectomy in large vessel occlusions patients with low NIHSS on presentation may be safe and has the potential to result in improved outcomes. Randomized clinical trials are warranted to establish the optimal management for this patient population.

show abstract

Section: Discussionmentioning

confidence: 93%

Mechanical Thrombectomy in Patients With Milder Strokes and Large Vessel Occlusions

Nagel

Bouslama

Krause

et al. 2018

Stroke

102

View full text Add to dashboard Cite

show abstract

“…A previous survey on neurointerventionalists showed increasing aggressiveness in selecting patients for MT after publication of the 2015 trials 18. Since that time, studies have demonstrated that MT is safe with a high rate of good outcomes in patients presenting with National Institute of Health Stroke Scale score of <8 19–22. A meta-analysis of seven randomized controlled MT trials showed significantly better functional outcomes with MT compared with medical management for patients presenting with more severe infarct burden as measured by pre-procedure ASPECTS scores as low as 3–6 23.…”

Section: Discussionmentioning

confidence: 99%

Real-world effects of late window neurothrombectomy: procedure rates increase without night-time bias

Williams

Leslie‐Mazwi

Hirsch

et al. 2019

J NeuroIntervent Surg

View full text Add to dashboard Cite

IntroductionWith the expansion of the interventional time window for stroke from emergent large vessel occlusion (ELVO), the rate of mechanical thrombectomy (MT) is expected to rise, potentially causing higher burnout rates and requiring hospitals to develop strategies for adequate coverage of these procedures.MethodsNeurointerventional physicians at 10 participating stroke centers prospectively recorded time requirements for all MT consultations over 30 consecutive 24-hour call periods, including both false positive consultations and MT procedures, during mid to late 2018. Consult start time, procedure start and end time, and data regarding commute to the hospital and delay in scheduled procedures were collected and compared with those from an identical prospective study performed in 2017.ResultsData were collected from a total of 300 days of call. A total of 166 procedures were performed (mean 0.55 per day), an increase from 0.32 per day in 2017. Overall mean MT direct time burden during each 24-hour call was 124 min (compared with 85 min in 2017). The percentage of consultations for thrombectomy varied based on time of day, with 87% of consults between the hours of midnight and 04:00 proceeding to thrombectomy compared with 37% between the hours of 16:00 and 20:00.ConclusionsMT procedural volumes have increased from one every 5 days in 2016 to one every 2 days in 2018. The highest percentage of consults leading to thrombectomy occur in the early morning hours after midnight. Compared with similar data from 2016 and 2017, call demands continue to escalate, representing a significant demand on neurointerventional teams.

show abstract

“…Several studies have suggested that MT subsequent to optimal medical therapy might improve the prognosis of patients with LVOS and mild symptoms. In one study, 75% of 41 patients with LVOS and a low NIHSS score (≤ 5) who received MT had a good outcome (an mRS score 0–2) at the 90-day follow-up[ 23 ]. In a retrospective analysis of 484 patients with stroke who received MT[ 12 ], 33 patients with LVOS and low NIHSS scores (≤ 8) were identified, of which 21 (63.6%) and 30 (90.9%) achieved favorable (mRS score 0–2) and moderate (mRS score 0–3) clinical outcomes at 90 days.…”

Section: Discussionmentioning

confidence: 99%

Endovascular thrombectomy versus medical treatment for large vessel occlusion stroke with mild symptoms: A meta-analysis

et al. 2018

View full text Add to dashboard Cite

It remains controversial as to whether mechanical thrombectomy (MT) is safer and more beneficial in patients with large vessel occlusion stroke (LVOS) presenting with a National Institutes of Health Stroke Scale score ≤ 8. We therefore conducted a meta-analysis of the published data.We searched PubMed and Embase and pooled relevant data in the meta-analyses using fixed effects models. Only studies that directly compared best medical therapy alone (BMT) with MT were included. We used odds ratios to analyze the associations between MT and 90-day functional outcome (evaluated using the modified Rankin Scale (mRS)), mortality, and rates of symptomatic intracerebral hemorrhage (sICH) in patients with LVOS and minor symptoms. Five studies including a total of 581 patients met our inclusion criteria. A significant difference was found that the patients treated with MT were associated with improved 90-day mRS score (OR, 1.68; 95% CI, 1.08–2.61) compared with BMT group. There was no difference in 90-day mortality between the two groups. However, sICH occurred more frequently in the MT group than the BMT group (OR, 3.89; 95% CI, 1.83–8.27). Patients with LVOS with minor or mild symptoms who underwent primary thrombectomy had a significantly improved 90-day mRS score compared to those who received BMT alone. Meanwhile, the risk of sICH was higher in the MT group than that in BMT group. Future randomized clinical controlled trials evaluating the role of endovascular reperfusion for LVOS with minimal symptoms are warranted.

show abstract

Mechanical thrombectomy in patients with M1 occlusion and NIHSS score ≤5: a single-centre experience

Cited by 34 publications

References 39 publications

Mechanical Thrombectomy in Patients With Milder Strokes and Large Vessel Occlusions

Mechanical Thrombectomy in Patients With Milder Strokes and Large Vessel Occlusions

Real-world effects of late window neurothrombectomy: procedure rates increase without night-time bias

Endovascular thrombectomy versus medical treatment for large vessel occlusion stroke with mild symptoms: A meta-analysis

Contact Info

Product

Resources

About