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Multicenter Study
. 2022 May;43(5):3105-3112.
doi: 10.1007/s10072-021-05771-5. Epub 2021 Nov 29.

Mechanical thrombectomy in acute ischemic stroke due to large vessel occlusion in the anterior circulation and low baseline National Institute of Health Stroke Scale score: a multicenter retrospective matched analysis

Andrea Maria Alexandre #  1 , Iacopo Valente #  1 , Alessandro Pedicelli  1 , Angelo Maria Pezzullo  2 , Francesca Colò  3 , Luca Scarcia  3 , Andrea Romi  3 , Mariangela Piano  4 , Antonio Macera  4 , Joseph Domenico Gabrieli  5 , Giacomo Cester  5 , Antonio Armando Caragliano  6 , Sergio Lucio Vinci  6 , Maria Ruggiero  7 , Christian Commodaro  7 , Andrea Saletti  8 , Guido Andrea Lazzarotti  9 , Mirco Cosottini  9 , Valerio Da Ros  10 , Luigi Bellini  10 , Emilio Lozupone  11 , Adriana Paladini  11 , Valerio Brunetti  12 , Roberta Morosetti  12 , Giovanni Frisullo  12 , Paolo Calabresi  3   12 , Giacomo Della Marca  3   12 , Aldobrando Broccolini  13   14
Affiliations
Multicenter Study

Mechanical thrombectomy in acute ischemic stroke due to large vessel occlusion in the anterior circulation and low baseline National Institute of Health Stroke Scale score: a multicenter retrospective matched analysis

Andrea Maria Alexandre et al. Neurol Sci. 2022 May.

Abstract

Background and purpose: The benefit of mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) and baseline mild neurological symptoms remains unclear. The purpose of this study was to evaluate the effectiveness of MT in this subgroup of patients.

Methods: The databases of 9 high-volume Italian stroke centers were retrospectively screened for patients with LVO in the anterior circulation and a baseline National Institute of Health Stroke Scale (NIHSS) score ≤ 5 that received either immediate MT or best medical management (BMM) with the possibility of rescue MT upon neurological worsening. Primary outcome measure was a modified Rankin Scale score of 0-1 at 90 days. Propensity score matching (PSM) analysis was used to estimate the treatment effect of immediate MT compared to BMM/rescue MT.

Results: Two hundred and seventy-two patients received immediate MT (MT group). The BMM/rescue MT group included 41 patients. The primary outcome was achieved in 78.6% (n = 246) of overall patients, with a higher proportion in the MT group (80.5% vs. 65.9%, p = 0.03) in unadjusted analysis. After PSM, patients in the MT group had a 19.5% higher chance of excellent outcome at 90 days compared to the BMM/Rescue MT group with a similar risk of death from any cause.

Conclusions: Our experience is in favor of a potential benefit of MT also in patients with LVO and a NIHSS score ≤ 5 at the time of groin puncture. Nonetheless, this issue waits for a clear-cut recommendation in a dedicated clinical trial.

Keywords: Acute ischemic stroke; Large vessel occlusion; Mechanical thrombectomy; Mild symptoms; NIHSS.

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