Outcomes after endovascular mechanical thrombectomy for low compared to high National Institutes of Health Stroke Scale (NIHSS): A multicenter study.

Autor: Abecassis IJ; Department of Neurological Surgery University of Louisville, Louisville, KY, USA. Electronic address: Isaac.Abecassis@uoflhealth.org., Almallouhi E; Department of Neurological Surgery Medical University of South Carolina, Charleston, SC, USA., Chalhoub R; Department of Neurological Surgery Medical University of South Carolina, Charleston, SC, USA., Kasab SA; Department of Neurological Surgery Medical University of South Carolina, Charleston, SC, USA., Bass E; Department of Neurological Surgery Medical University of South Carolina, Charleston, SC, USA., Ding D; Department of Neurological Surgery University of Louisville, Louisville, KY, USA., Saini V; Department of Neurological Surgery University of Miami, Miami, FL, USA., Burks JD; Department of Neurological Surgery University of Miami, Miami, FL, USA., Maier IL; Department of Neurology University Medicine Göttingen, Germany., Psychogios MN; Department of Neuroradiology University Hospital Basel, Switzerland., Liman J; Department of Neurology University Medicine Göttingen, Germany., Alawieh A; Department of Neurosurgery Emory University School of Medicine, Atlanta, GA, USA., Wolfe S; Department of Neurological Surgery Wake Forest School of Medicine, Winston Salem, NC, USA., Arthur AS; Department of Neurosurgery Semmes-Murphey Neurologic and Spine Clinic, University of Tennessee Health Science Center, Memphis, TN, USA., Shaban A; Department of Neurology University of Iowa, Iowa City, IA, USA., Dumont T; Department of Neurosurgery University of Arizona Health Sciences, Tucson, AZ, USA., Kan P; Department of Neurosurgery University of Texas Medical Branch at Galveston, Galveston, TX, USA., Kim JT; Department of Neurology Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, South Korea., De Leacy R; Department of Neurosurgery Mount Sinai Health System, New York, NY, USA., Osbun J; Department of Neurosurgery Washington University of School of Medicine, St.Louis, MO, USA., Rai A; Department of Radiology West Virginia School of Medicine, Morgantown, WV, USA., Jabbour P; Department of Neurosurgery Thomas Jefferson University Hospitals, Philadelphia, PA, USA., Grossberg JA; Department of Neurosurgery Emory University School of Medicine, Atlanta, GA, USA., Park MS; Department of Neurosurgery University of Virginia, Charlottesville, VA, USA., Crosa R; Department of Neurosurgery Endovascular Neurological Center, Montevideo, Uruguay., Mascitelli J; Department of Neurosurgery University of Texas Health Science Center at San Antonio, TX, USA., Levitt MR; Department of Neurosurgery University of Washington, Seattle, WA, USA., Polifka A; Department of Neurosurgery University of Florida, Gainesville, FL, USA., Casagrande W; Department of Cerebrovascular and Endovascular Neurosurgery Hospital Juan Fernandez, Buenos Aires, Argentina., Yoshimura S; Department of Neurosurgery Hyogo College of Medicine, Nishinomiya, Hyogo, Japan., Matouk C; Department of Neurosurgery Yale School of Medicine, New Haven, CT, USA., Williamson RW; Department of Neurosurgery Allegheny Health Network, Pittsburgh, PA, USA., Gory B; Department of Diagnostic and Therapeutic Neuroradiology Centre Hospitalier Régional Universitaire de Nancy, Nancy, France., Mokin M; Department of Neurosurgery University of South Florida, Tampa, Florida, USA., Fragata I; Neuroradiology Department Hospital São José Centro Hospitalar, Lisboa, Portugal., Romano DG; Department Neuroradiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy., Chowdry S; Department of Neurosurgery NorthShore University Health System, Evanston, IL, USA., Moss M; Department of Interventional Neuroradiology Washington Regional Medical Center, Fayetteville, AR, USA., Behme D; Department of Neuroradiology University Hospital Magdeburg, Germany., Limaye K; Departments of Neurology, Neurological Surgery, and Radiology Indiana University, Indianapolis, IN, USA., Spiotta AM; Department of Neurological Surgery Medical University of South Carolina, Charleston, SC, USA., Starke RM; Department of Neurological Surgery University of Miami, Miami, FL, USA.
Jazyk: angličtina
Zdroj: Clinical neurology and neurosurgery [Clin Neurol Neurosurg] 2023 Feb; Vol. 225, pp. 107592. Date of Electronic Publication: 2023 Jan 13.
DOI: 10.1016/j.clineuro.2023.107592
Abstrakt: Objective: The role of endovascular mechanical thrombectomy (MT) in patients presenting with "minor" stroke is uncertain. We aimed to compare outcomes after MT for ischemic stroke patients presenting with National Institutes of Health Stroke Scale (NIHSS) 5 and - within the low NIHSS cohort - identify predictors of a favorable outcome, mortality, and symptomatic intracranial hemorrhage (ICH).
Methods: We retrospectively analyzed a prospectively maintained, international, multicenter database.
Results: The study cohort comprised a total of 7568 patients from 29 centers. NIHSS was low (<5) in 604 patients (8%), and > 5 in 6964 (92%). Patients with low NIHSS were younger (67 + 14.8 versus 69.6 + 14.7 years, p < 0.001), more likely to have diabetes (31.5% versus 26.9%, p = 0.016), and less likely to have atrial fibrillation (26.6% versus 37.6%, p < 0.001) compared to those with higher NIHSS. Radiographic outcomes (TICI > 2B 84.6% and 84.3%, p = 0.412) and complication rates (8.1% and 7.2%, p = 0.463) were similar between the low and high NIHSS groups, respectively. Clinical outcomes at every follow up interval, including NIHSS at 24 h and discharge, and mRS at discharge and 90 days, were better in the low NIHSS group, however patients in the low NIHSS group experienced a relative decline in NIHSS from admit to discharge. Mortality was lower in the low NIHSS group (10.4% versus 24.5%, p < 0.001).
Conclusions: Relative to patients with high NIHSS, MT is safe and effective for stroke patients with low NIHSS, and it is reasonable to offer it to appropriately selected patients presenting with minor stroke symptoms. Our findings justify efforts towards a randomized trial comparing MT versus medical management for patients with low NIHSS.
(Copyright © 2023 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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