Table 2

Natural history (medical therapy only, no IV tPA) and thrombectomy outcomes in patients with ELVO and mild symptoms

StudyStroke severityStudy groupsOutcomes
Haussen et al, 201837 NIHSS <688 Patients with medical therapy, 30 with EVT.
Retrospective, matched analysis

  • EVT predicted favorable NIHSS shift (β −3.7, 95% CI −6.0 to −1.5, p=0.02).

Haussen et al, 201738 NIHSS <622 Patients with medical therapy, 10 with EVT

  • 9/22 (41%) of medically treated patients deteriorated and required thrombectomy.

  • EVT predicted favorable NIHSS shift β −4.2, 95% CI −8.2 to −0.1, p=0.04)

Dargazanli et al, 201740 NIHSS <8170 Patients with medical therapy, 131 with EVT

  • 24/131 (18%) of medical treated patients deteriorated and required EVT.

  • mRS 0–1 at 3 months more common with thrombectomy (adjusted OR=1.79, 95% CI 1.02 to 3.14, p=0.043).

  • Similar rates of mRS 0–2 (OR=1.33, 95% CI 0.71 to 2.50, p=0.38)

Heldner et al, 201555 NIHSS <644 Patients treated with medical therapy

  • Worsening of NIHSS (increase of score ≥1) within the first 24 hours in 10/44 (23%)

  • Worsening of NIHSS at 3-month follow-up in 17/41 (41%)

Mokin et al, 201439 NIHSS <8204 Patients treated with medical therapy

  • At discharge, 17% of patients with NIHSS 0–4 and 36% with NIHSS 5–7 could not ambulate independently

Rajajee et al, 200656 NIHSS <539 Patients treated with medical therapy

  • 3/8 (38%) patients with ELVO vs 1/31 (3%) patient without ELVO had early neurologic deterioration with infarct expansion on MRI (OR=18, 95% CI 1.6 to 209, p=0.02).

  • ELVO, emergent large vessel occlusion; EVT, endovascular therapy; IV, intravenous; MRI, magnetic resonance imaging; mRS, modified Rankin scale; NIHSS, National Institutes of Health Stroke Scale; tPA, tissue plasminogen activator.