PT  - JOURNAL ARTICLE
AU  - Diogo C Haussen
AU  - Fabricio O Lima
AU  - Mehdi Bouslama
AU  - Jonathan A Grossberg
AU  - Gisele S Silva
AU  - Michael H Lev
AU  - Karen Furie
AU  - Walter Koroshetz
AU  - Michael R Frankel
AU  - Raul G Nogueira
TI  - Thrombectomy versus medical management for large vessel occlusion strokes with minimal symptoms: an analysis from STOPStroke and GESTOR cohorts
AID  - 10.1136/neurintsurg-2017-013243
DP  - 2017 Aug 02
TA  - Journal of NeuroInterventional Surgery
PG  - neurintsurg-2017-013243
4099  - http://jnis.bmj.com/content/early/2017/08/02/neurintsurg-2017-013243.short
4100  - http://jnis.bmj.com/content/early/2017/08/02/neurintsurg-2017-013243.full
AB  - Introduction It remains unclear whether patients presenting with large vessel occlusion strokes and mild symptoms benefit from thrombectomy.Objective To compare outcomes of endovascular therapy versus medical management in patients with large vessel occlusion strokes and National Institute of Health Stroke Scale (NIHSS) score ≤5.Methods This was a retrospective analysis combining two large prospectively collected datasets including patients with (1) admission NIHSS score ≤5, (2) premorbid modified Rankin Scale (mRS) score 0–2, and (3) middle cerebral-M1/M2, intracranial carotid, anterior cerebral or basilar artery occlusions. Groups receiving (1) endovascular treatment and (2) medical management were compared. The primary and secondary outcome measures were NIHSS shift (discharge NIHSS minus admission NIHSS) and the rates of mRS 0–2 at discharge and 3–6 months, respectively. Univariate, multivariate, and matched analyses were performed.Results Eighty-eight patients received medical management and 30 thrombectomy. Multivariable analysis indicated thrombectomy was the only predictor of favorable NIHSS shift (β −3.7, 95% CI −6.0 to −1.5, p=0.02), as well as independence at discharge (β −21.995% CI −41.4to −20.8, p<0.01) and 3–6-month follow-up (β −21.1, 95% CI −39.1 to −19.7, p<0.01). A matched analysis (based on age, baseline NIHSS and intravenous tissue plasminogen activator use) produced 26 pairs. Endovascular therapy was statistically associated with lower NIHSS at discharge (p=0.04), favorable NIHSS shift (p=0.03), and increased independence rates at discharge (p=0.03) and 3–6-month follow-up (p=0.04).Conclusion In patients presenting with minimal stroke symptoms (NIHSS score ≤5) and large vessel occlusion strokes, mechanical thrombectomy appears to be associated with a favorable shift of NIHSS at discharge, as well as higher rates of independence at discharge and long-term follow-up. Confirmatory prospective studies are warranted.