Thrombectomy or intravenous thrombolysis in patients with NIHSS of 5 or less?

被引：27

作者：

Da Ros, Valerio ^{[1
,2
]}

Cortese, Jonathan ^{[2
]}

Chassinc, Olivier ^{[3
]}

Rouchaud, Aymeric ^{[2
]}

Sarov, Mariana ^{[3
]}

Caroff, Jildaz ^{[2
]}

Mihalea, Cristian ^{[1
,2
]}

Minosse, Silvia ^{[1
]}

Taifas, Irina ^{[3
]}

Scaggiante, Jacopo ^{[1
]}

Greco, Laura ^{[1
]}

Ikka, Leon ^{[2
]}

Ben Achour, Nidhal ^{[2
]}

Di Giuliano, Francesca ^{[1
]}

Ozanne, Augustin ^{[2
]}

Legris, Nicolas ^{[3
]}

Diomedi, Marina ^{[4
]}

Sallustio, Fabrizio ^{[4
]}

Floris, Roberto ^{[1
]}

Denier, Christian ^{[3
]}

Spelle, Laurent ^{[2
]}

机构：

[1] Tor Vergata Univ Hosp, Dept Diagnost Imaging & Intervent Radiol, Viale Oxford 81, I-00133 Rome, Italy

[2] Hop Bicetre, Intervent Neuroradiol NEURI Ctr, 78 Rue Gen Leclerc, F-94270 Le Kremlin Bicetre, France

[3] Bicetre Hosp, Dept Neurol, 78 Rue Gen Leclerc, F-94270 Le Kremlin Bicetre, France

[4] Tor Vergata Univ Hosp, Dept Neurol, Stroke Unit, Viale Oxford 81, I-00133 Rome, Italy

来源：

JOURNAL OF NEURORADIOLOGY | 2019年 / 46卷 / 04期

关键词：

ACUTE ISCHEMIC-STROKE; EARLY NEUROLOGICAL DETERIORATION; TISSUE-PLASMINOGEN ACTIVATOR; HEALTH-CARE PROFESSIONALS; VESSEL OCCLUSION STROKES; ENDOVASCULAR TREATMENT; MINIMAL SYMPTOMS; EARLY MANAGEMENT; TOO GOOD; MILD;

D O I：

10.1016/j.neurad.2019.01.089

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: - To compare outcomes of minor stroke patients with intracranial vessel occlusions (IVO) underwent mechanical thrombectomy (MT) versus those treated with intravenous thrombolysis alone (IVT). Methods: - We retrospectively reviewed two large prospective stroke databases from two European centers searching for patients admitted with minor stroke (i.e. NIHSS Score <= 5), baseline mRS = 0 and occlusion of the M1-M2 segment of the middle cerebral artery (MCA). Groups receiving (A) IVT alone and (B) MT+/-IVT were compared. Primary outcome measures were MT safety, successful recanalization rate (mTICI 2b-3) and NIHSS shift (discharge NIHSS minus admission NIHSS); secondary outcomes included discharge rates and excellent outcome (mRS 0-1) at 3 months. Univariate and multivariate analyses were performed. Results: - Thirty-two patients were enrolled in Group B (19 MT alone; 13 MT + IVT) and 24 in Group A. Successful recanalization (mTICI 2b-3) was obtained in 100% of cases in Group B vs 38% in Group A. Symptomatic hemorrhagic transformation rate did not differ between the two groups. Multivariate analysis reported MT as the only predictor of early (< 12h) favorable NIHSS shift and lower NIHSS at discharge. Moreover, discharge at home and excellent outcome at 3-month follow-up were statistically associated with MT. Conclusions: - MT in patients with minor strokes and intracranial vessel occlusion (IVO) is safe and can determine a rapid improvement of NIHSS Score. MT seems also associated with a higher rate of patients discharged at home after hospitalization and better clinical outcome at 3-month follow-up. Larger randomized trials are warranted to confirm these results. (C) 2019 Elsevier Masson SAS. All rights reserved.

引用

页码：225 / 230

页数：6

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