Thrombectomy versus medical management for large vessel occlusion strokes with minimal symptoms: an analysis from STOPStroke and GESTOR cohorts

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dc.citation.issue4
dc.citation.volumev. 10
dc.contributor.authorHaussen, Diogo C.
dc.contributor.authorLima, Fabricio O.
dc.contributor.authorBouslama, Mehdi
dc.contributor.authorGrossberg, Jonathan A.
dc.contributor.authorSilva, Gisele Sampaio [UNIFESP]
dc.contributor.authorLev, Michael H.
dc.contributor.authorFurie, Karen
dc.contributor.authorKoroshetz, Walter
dc.contributor.authorFrankel, Michael R.
dc.contributor.authorNogueira, Raul G.
dc.coverageLondon
dc.date.accessioned2020-07-20T16:31:09Z
dc.date.available2020-07-20T16:31:09Z
dc.date.issued2018
dc.description.abstractIntroduction It remains unclear whether patients presenting with large vessel occlusion strokes and mild symptoms benefit from thrombectomy. Objective To compare outcomes of endovascular therapy versus medical management in patients with large vessel occlusion strokes and National Institute of Health Stroke Scale (NIHSS) score 5. Methods This was a retrospective analysis combining two large prospectively collected datasets including patients with (1) admission NIHSS score 5, (2) premorbid modified Rankin Scale (mRS) score 0-2, and (3) middle cerebral-M1/M2, intracranial carotid, anterior cerebral or basilar artery occlusions. Groups receiving (1) endovascular treatment and (2) medical management were compared. The primary and secondary outcome measures were NIHSS shift (discharge NIHSS minus admission NIHSS) and the rates of mRS 0-2 at discharge and 3-6 months, respectively. Univariate, multivariate, and matched analyses were performed. Results Eighty-eight patients received medical management and 30 thrombectomy. Multivariable analysis indicated thrombectomy was the only predictor of favorable NIHSS shift ( -3.7, 95%CI -6.0 to -1.5, p=0.02), as well as independence at discharge ( -21.995% CI -41.4to -20.8, p<0.01) and 3-6-month follow-up ( -21.1, 95% CI -39.1 to -19.7, p<0.01). A matched analysis (based on age, baseline NIHSS and intravenous tissue plasminogen activator use) produced 26 pairs. Endovascular therapy was statistically associated with lower NIHSS at discharge (p=0.04), favorable NIHSS shift (p=0.03), and increased independence rates at discharge (p=0.03) and 3-6-month follow-up (p=0.04). Conclusion 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 of NIHSS at discharge, as well as higher rates of independence at discharge and long-term follow-up. Confirmatory prospective studies are warranted.en
dc.description.affiliationEmory Univ, Grady Mem Hosp, Atlanta, FL USA
dc.description.affiliationUniv Fortaleza, Fortaleza, Ceara, Brazil
dc.description.affiliationUniv Fed Sao Paulo, Sao Paulo, Brazil
dc.description.affiliationHosp Israelita Albert Einstein, Sao Paulo, Brazil
dc.description.affiliationHarvard Med Sch, Massachusetts Gen Hosp, Boston, MA USA
dc.description.affiliationBrown Univ, Providence, RI 02912 USA
dc.description.affiliationNINDS, Bldg 36,Rm 4D04, Bethesda, MD 20892 USA
dc.description.affiliationUnifespUniv Fed Sao Paulo, Sao Paulo, Brazil
dc.description.sourceWeb of Science
dc.format.extent325-329
dc.identifierhttp://dx.doi.org/10.1136/neurintsurg-2017-013243
dc.identifier.citationJournal Of Neurointerventional Surgery. London, v. 10, n. 4, p. 325-329, 2018.
dc.identifier.doi10.1136/neurintsurg-2017-013243
dc.identifier.issn1759-8478
dc.identifier.urihttps://repositorio.unifesp.br/handle/11600/55742
dc.identifier.wosWOS:000428921600005
dc.language.isoeng
dc.publisherBmj Publishing Group
dc.relation.ispartofJournal Of Neurointerventional Surgery
dc.rightsinfo:eu-repo/semantics/restrictedAccess
dc.subjectstrokeen
dc.subjectinterventionen
dc.subjectthrombectomyen
dc.titleThrombectomy versus medical management for large vessel occlusion strokes with minimal symptoms: an analysis from STOPStroke and GESTOR cohortsen
dc.typeinfo:eu-repo/semantics/article
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