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Endovascular Treatment Versus Best Medical Therapy in Acute Ischemic Stroke Patients with Mild Symptoms

Authors
Nicholson, P.Byun, Jun SooLu, H.Hilditch, C.A.Brinjikji, W.Agid, R.Casaubon, L.K.Krings, T.Schaafsma, J.D.Mendes-Pereira, V.
Issue Date
Dec-2020
Publisher
Elsevier Inc.
Keywords
EVT; Low NIHSS; Medical management; Mild stroke; Stroke
Citation
World Neurosurgery, v.144, pp 837 - 841
Pages
5
Journal Title
World Neurosurgery
Volume
144
Start Page
837
End Page
841
URI
https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/47679
DOI
10.1016/j.wneu.2020.09.080
ISSN
1878-8750
1878-8769
Abstract
Background: The benefit of endovascular treatment (EVT) for acute ischemic stroke patients with mild deficits is unknown. We sought to evaluate the natural history of patients with a low National Institute of Health Stroke Score (NIHSS) and an intracranial occlusion. Methods: We included patients with a computed tomography angiogram–proven intracranial arterial occlusion who presented within 24 hours of symptom onset with an NIHSS of ≤6. We compared outcomes of patients who were treated with EVT and those who were not by performing propensity score–matched analysis. Primary outcome was modified Rankin score (mRS) at 90 days. Results: A total of 66 patients were included: 38 were men (57.6%) with a median age of 69 (interquartile range [IQR], 57–79.5) years. Median NIHSS was 3 (IQR, 2–5). Median time from symptom onset to presentation was 2.87 hours (IQR, 1.3–5.9). Forty of the total cohort underwent best medical therapy alone (60.6%), whereas 26 underwent EVT (39.4%). Nineteen of the 26 patients who underwent EVT had a good clinical outcome (mRS ≤2) (73.1%), compared with 29 of 40 best medical therapy patients (72.5%) (odds ratio, 0.833 with 95% confidence interval, 0.263–2.631; P = 0.755). Following propensity score adjustment there was a tendency toward lower mRS following EVT (P = 0.051). Conclusions: Despite the higher number of proximal occlusions in the EVT group, overall outcomes were similar, with >70% of patients in each cohort having a good outcome at 90 days. © 2020 Elsevier Inc.
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