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Abstract
Background and Purpose Acute ischaemic 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 previously described.
Methods We retrospectively reviewed discharge outcomes in patients with 0–7 admission NIHSS score due to proximal intracranial large vessel occlusion (based on computed-tomographic angiography results) who were excluded from intravenous thrombolysis with recombinant tissue plasminogen activator and endovascular intraarterial stroke interventions.
Results Among the 204 patients included in our final 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 a great variability in functional outcomes at discharge with a trend toward worse outcomes in patients with higher NIHSS score on admission.
Conclusions Selected patients with stroke who fall under the category of “lower” NIHSS score (that is, 0–7 range) and are diagnosed with intracranial vessel occlusion can have poor functional outcome at discharge. These patients, if not eligible for IV thrombolysis, might benefit from IA revascularisation therapies, given their poor prognosis. The NIHSS cutoff point of 8 when considering patients for endovascular IA interventions might need to be revisited in the future.
Fisher's Exact 2-side Test p-value=0.0010
Disclosures M. Mokin: 1; C; Toshiba Educational Grant. M. Masud: None. T. Dumont: None. T. Kass-Hout: 1; C; Genentech. K. Snyder: 1; C; Toshiba Stroke Research Fellow. 2; C; Codman Neurovascular. 6; C; Toshiba for Lectures. A. Siddiqui: 1; C; NINDS 1R01NS064592-01A1, University at Buffalo. 2; C; Codman & Shurtleff, Inc, Concentric Medical, ev3/Covidien Vascular Therapies, GuidePoint Global Consulting, Penumbra. 3; C; Codman & Shurtleff, Inc, Genentech. 4; C; Hotspur, Intratech Medical, StimSox, Valor Medical. 6; C; Abbott Vascular, American Association of Neurological Surgeons’ courses, Genentech, Neocure Group LLC, Codman & Shurtleff, Inc. E. Levy: 1; C; ev3/Covidien Vascular Therapies, Boston Scientific, Codman & Shurtleff, Inc. 2; C; TheraSyn Sensors, Inc, ev3/Covidien Vascular Therapies, & Shurtleff, Inc. 4; C; Intratech Medical Ltd, Mynx/Access Closure. 6; C; Honoraria: Boston Scientific Corporation.