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Ischemic stroke
Original research
Outcomes in patients with acute ischemic stroke from proximal intracranial vessel occlusion and NIHSS score below 8
  1. Maxim Mokin1,2,
  2. Muhammad W Masud3,4,
  3. Travis M Dumont1,2,
  4. Ghasan Ahmad3,4,
  5. Tareq Kass-Hout3,4,
  6. Kenneth V Snyder1,2,3,5,6,
  7. L Nelson Hopkins1,2,5,6,7,
  8. Adnan H Siddiqui1,2,5,6,
  9. Elad I Levy1,2,5,6
  1. 1Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA
  2. 2Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA
  3. 3Department of Neurology, University at Buffalo, State University of New York, Buffalo, New York, USA
  4. 4Department of Neurology, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA
  5. 5Department of Radiology, University at Buffalo, State University of New York, Buffalo, New York, USA
  6. 6Toshiba Stroke and Research Vascular Center, University at Buffalo, State University of New York, Buffalo, New York, USA
  7. 7Jacobs Institute, Buffalo, New York, USA
  1. Correspondence to Dr E I Levy, Department of Neurosurgery, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY 14203 USA; elevy{at}ubns.com

Abstract

Objective Acute ischemic stroke due to proximal intracranial vessel occlusion is associated with poor prognosis and neurologic outcomes. Outcomes specifically in patients with stroke due to these occlusions and lower National Institutes of Health Stroke Scale (NIHSS) scores (0–7 range) have not been described previously.

Methods We retrospectively reviewed discharge outcomes (reported in our ‘Get With the Guidelines-Stroke’ database) in patients with an admission NIHSS score of 0–7 due to proximal intracranial large vessel occlusion (based on CT angiography results) who were excluded from receiving intravenous (IV) thrombolysis with recombinant tissue plasminogen activator and endovascular intra-arterial (IA) stroke interventions.

Results Among the 204 patients included in our analysis, younger age and lower admission NIHSS score (0–4 range) were strong predictors of good outcome (defined as ability to ambulate independently) at discharge whereas female sex was a predictor of poor outcome. There was no significant difference between cerebrovascular risk factors, specific sites of occlusion, or presenting symptoms and outcomes at discharge. There was great variability in functional outcomes at discharge and discharge disposition (home versus acute or subacute facility or nursing home versus death/hospice) with a trend toward worse outcomes in patients with higher (5–7 range) NIHSS scores on admission.

Conclusions Patients with acute stroke due to large vessel occlusion and low admission NIHSS scores (0–7 range) may have poor functional outcomes at discharge. These patients, if not eligible for IV thrombolysis, might benefit from IA revascularization therapies.

  • Stroke

https://doi.org/10.1136/neurintsurg-2013-010720

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