Thrombectomy vs medical management in low NIHSS acute anterior circulation stroke
Language English Country United States Media print-electronic
Document type Comparative Study, Journal Article, Multicenter Study, Observational Study
PubMed
32989100
PubMed Central
PMC7836655
DOI
10.1212/wnl.0000000000010955
PII: WNL.0000000000010955
Knihovny.cz E-resources
- MeSH
- Arterial Occlusive Diseases therapy MeSH
- Endovascular Procedures * statistics & numerical data MeSH
- Fibrinolytic Agents administration & dosage MeSH
- Outcome Assessment, Health Care * statistics & numerical data MeSH
- Ischemic Stroke drug therapy therapy MeSH
- Middle Aged MeSH
- Humans MeSH
- Follow-Up Studies MeSH
- Cerebral Arterial Diseases therapy MeSH
- Disease Progression * MeSH
- Registries * MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Severity of Illness Index * MeSH
- Thrombectomy * statistics & numerical data MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Observational Study MeSH
- Comparative Study MeSH
- Names of Substances
- Fibrinolytic Agents MeSH
OBJECTIVE: To undertake an effectiveness and safety analysis of EVT in patients with LVO and NIH Stroke Scale (NIHSS) score ≤6 using datasets of multicenter and multinational nature. METHODS: We pooled patients with anterior circulation occlusion from 3 prospective international cohorts. Patients were eligible if presentation occurred within 12 hours from last known well and baseline NIHSS ≤6. Primary outcome was modified Rankin Scale (mRS) score 0-1 at 90 days. Secondary outcomes included neurologic deterioration at 24 hours (change in NIHSS of ≥2 points), mRS 0-2 at 90 days, and 90-day all-cause mortality. We used propensity score matching to adjust for nonrandomized treatment allocation. RESULTS: Among 236 patients who fit inclusion criteria, 139 received EVT and 97 received medical management. Compared to medical management, the EVT group was younger (65 vs 72 years; p < 0.001), had more proximal occlusions (p < 0.001), and less frequently received concurrent IV thrombolysis (57.7% vs 71.2%; p = 0.04). After propensity score matching, clinical outcomes between the 2 groups were not significantly different. EVT patients had an 8.6% (95% confidence interval [CI] -8.8% to 26.1%) higher rate of excellent 90-day outcome, despite a 22.3% (95% CI, 3.0%-41.6%) higher risk of neurologic deterioration at 24 hours. CONCLUSIONS: EVT for LVO in patients with low NIHSS score was associated with increased risk of neurologic deterioration at 24 hours. However, both EVT and medical management resulted in similar proportions of excellent clinical outcomes at 90 days. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for patients with acute anterior circulation ischemic strokes and LVO with NIHSS < 6, EVT and medical management result in similar outcomes at 90 days.
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