Endovascular Thrombectomy for Mild Strokes: How Low Should We Go? A Multicenter Cohort Study

Authors

Amrou Sarraj
Ameer E. Hassan, The University of Texas Rio Grande Valley
Sean I. Savitz
James C. Grotta
Chunyan Cai
Kaushik N. Parsha
Christine M. Farrell
Bita Imam
Clark W. Sitton
Sujan T. Reddy

Document Type

Article

Publication Date

2018

Abstract

Background and Purpose:Endovascular thrombectomy (EVT) is effective for acute ischemic stroke with large vessel occlusion (LVO) and NIHSS ≥6. However, EVT benefit for mild deficits LVOs (NIHSS

Methods: A retrospective cohort of patients with anterior circulation LVO and NIHSSoutcome; mRS=0–2 was the secondary. Symptomatic intracerebral hemorrhage (sICH) was the safety outcome. Clinical outcomes were compared through a multivariable logistic regression after adjusting for age, presentation NIHSS, time-last-seen-normal-to-presentation, center, IV-alteplase, ASPECTS, and thrombus location. We then performed propensity score matching as a sensitivity analysis. Results were also stratified by thrombus location.

Results: 214 patients (EVT-124, medical management-90) were included from 8 US and Spain centers between January/2012 and March/2017. The groups were similar in age, ASPECTS, IValteplase rate and time-last-seen-normal-to-presentation. There was no difference in mRS=0–1 between EVT and medical management (55.7% versus 54.4%, respectively, aOR=1.3, 95%CI=0.64–2.64, p=0.47). Similar results were seen for mRS=0–2 (63.3% EVT versus 67.8% medical management, aOR=0.9, 95%CI=0.43–1.88, p=0.77). In a propensity matching analysis, there was no treatment effect in 62 matched pairs (53.5%EVT, 48.4% medical management; OR=1.17, 95%CI=0.54–2.52, p=0.69). There was no statistically significant difference when stratified by any thrombus location; M1 approached significance (p=0.07). sICH rates were higher with thrombectomy (5.8% EVT versus 0% medical management, p=0.02).

Conclusions: Our retrospective multicenter cohort study showed no improvement in excellent and independent functional outcomes in mild strokes (NIHSS

Recommended Citation

Sarraj, A., Hassan, A., Savitz, S. I., Grotta, J. C., Cai, C., Parsha, K. N., Farrell, C. M., Imam, B., Sitton, C. W., Reddy, S. T., Kamal, H., Goyal, N., Elijovich, L., Reishus, K., Krishnan, R., Sangha, N., Wu, A., Costa, R., Malik, R., Mir, O., … Ribo, M. (2018). Endovascular Thrombectomy for Mild Strokes: How Low Should We Go?. Stroke, 49(10), 2398–2405. https://doi.org/10.1161/STROKEAHA.118.022114

Publication Title

Stroke

DOI

10.1161/STROKEAHA.118.022114

Academic Level

faculty

Mentor/PI Department

Neurology