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

被引：26

作者：

Alexandre, Andrea Maria ^{[1
]}

Valente, Iacopo ^{[1
]}

Pedicelli, Alessandro ^{[1
]}

Pezzullo, Angelo Maria ^{[2
]}

Colo, Francesca ^{[3
]}

Scarcia, Luca ^{[3
]}

Romi, Andrea ^{[3
]}

Piano, Mariangela ^{[4
]}

Macera, Antonio ^{[4
]}

Gabrieli, Joseph Domenico ^{[5
]}

Cester, Giacomo ^{[5
]}

Caragliano, Antonio Armando ^{[6
]}

Vinci, Sergio Lucio ^{[6
]}

Ruggiero, Maria ^{[7
]}

Commodaro, Christian ^{[7
]}

Saletti, Andrea ^{[8
]}

Lazzarotti, Guido Andrea ^{[9
]}

Cosottini, Mirco ^{[9
]}

Da Ros, Valerio ^{[10
]}

Bellini, Luigi ^{[10
]}

Lozupone, Emilio ^{[11
]}

Paladini, Adriana ^{[11
]}

Brunetti, Valerio ^{[12
]}

Morosetti, Roberta ^{[12
]}

Frisullo, Giovanni ^{[12
]}

Calabresi, Paolo ^{[3
,12
]}

Della Marca, Giacomo ^{[3
,12
]}

Broccolini, Aldobrando ^{[3
,12
]}

机构：

[1] Fdn Policlin Univ A Gemelli IRCCS, UOC Radiol & Neuroradiol, Area Diagnost Immagini, Rome, Italy

[2] Univ Cattolica S Cuore, Dipartimento Sci Vita & Sanita Pubbl, Rome, Italy

[3] Univ Cattolica S Cuore, Rome, Italy

[4] ASST Grande Osped Metropolitano Niguarda, Neuroradiol, Milan, Italy

[5] Azienda Osped Univ Padova, UOC Neuroradiol, Padua, Italy

[6] AOU Policlin G Martino, UO Neuroradiol, Messina, Italy

[7] AUSL Romagna, UO Neuroradiol, Cesena Rimini, Italy

[8] Azienda Osped Univ St Anna, Neuroradiol Interventist, Ferrara, Italy

[9] Azienda Osped Univ Pisana, UO Neuroradiol, Pisa, Italy

[10] Policlin Univ Roma Tor Vergata, Dipartimento Biomed & Prevenz, Rome, Italy

[11] Osped V Fazzi, UOC Neuroradiol, Lecce, Italy

[12] Fdn Policlin Univ A Gemelli IRCCS, UOC Neurol, Rome, Italy

来源：

NEUROLOGICAL SCIENCES | 2022年 / 43卷 / 05期

关键词：

Acute ischemic stroke; Mild symptoms; NIHSS; Large vessel occlusion; Mechanical thrombectomy; MIDDLE CEREBRAL-ARTERY; NIHSS SCORE; THERAPY; GUIDELINES; MANAGEMENT; SYMPTOMS; OUTCOMES;

D O I：

10.1007/s10072-021-05771-5

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

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.

引用

页码：3105 / 3112

页数：8

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