Thrombectomy Compared to Medical Management for Large Vessel Occlusion Strokes with Minimal Symptoms
August 9, 2017—Online in Journal of NeuroInterventional Surgery (JNIS), Diogo C. Haussen, MD, et al recently published findings of an analysis from the STOPStroke and GESTOR (Grady Endovascular Stroke Outcomes Registry) cohorts to compare outcomes of endovascular therapy versus medical management in patients with large vessel occlusion strokes and National Institute of Health Stroke Scale (NIHSS) scores ≤ 5.
This retrospective analysis combined the two large prospectively collected datasets including patients with the following: admission NIHSS score ≤ 5, premorbid modified Rankin Scale (mRS) score 0–2, and middle cerebral–M1/M2, intracranial carotid, anterior cerebral, or basilar artery occlusions.
The investigators compared groups undergoing endovascular treatment (n = 30) and medical management (n = 88). The primary and secondary outcome measures were NIHSS score shift (discharge NIHSS score minus admission NIHSS score) and the rates of mRS score 0–2 at discharge and at 3 to 6 months, respectively. Additionally, univariate, multivariate, and matched analyses were performed.
As summarized in JNIS, multivariable analysis indicated that thrombectomy was the only predictor of favorable NIHSS score shift (β -3.7; 95% confidence interval [CI], -6.0 to -1.5; P = .02), as well as independence at discharge (β -21.9; 95% CI, -41.4 to -20.8; P < .01) and 3- to 6-month follow-up (β -21.1; 95% CI, -39.1 to -19.7; P < .01). A matched analysis (based on age, baseline NIHSS score, and intravenous tissue plasminogen activator use) produced 26 pairs. Endovascular therapy was statistically associated with the following: lower NIHSS score at discharge (P = .04), favorable NIHSS score shift (P = .03), and increased independence rates at discharge (P = .03) and at 3- to 6-month follow-up (P = .04).
The investigators concluded that 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 in NIHSS scores at discharge, as well as higher rates of independence at discharge and long-term follow-up. Confirmatory prospective studies are warranted, advised the investigators in JNIS.