Abstract WP8: Minor Stroke With Large Vessel Occlusion
Background and Rationale: Minor stroke symptoms (NIHSS </= 8) with large vessel occlusion (LVO) comprise an important population that has not been thoroughly studied in the recent intra-arterial therapy (IAT) trials. A subset of patients with mild symptoms may benefit from IAT. We attempt to characterize those patients.
Methods: We retrospectively reviewed patients who presented with minor stroke symptoms and LVO between the years of 2002 and 2015. In our primary analysis, we divided patients who underwent IAT based on 90 day modified Rankin Scale (mRS) into favorable (mRS 0-2) vs unfavorable outcome (mRS >2). Using unpaired t-test, we compared demographics, comorbidities, NIHSS at presentation, use of IV tPA, stent retrievers, IAT within 8 hours from last known well and location of LVO. In our secondary analysis, we compared the two cohorts with matched patients who received tPA only without IAT.
Results: Risk of complication of patients undergoing IAT was low (4%). The overall good outcome in patients undergoing IAT was 62.5%. Patients with favorable outcome tended to have anterior circulation occlusion (70% vs 41.6%, p = 0.03) and tandem occlusions (32.5% vs 8.3%, p = 0.03) with higher rates of TICI 2b/3 recanalization (90% vs 62.5%, p = 0.008). There was no difference in favorable outcome between patients who received IV tPA only vs IAT +/- IV tPA (68.5% vs 62.5%, p = 0.5). However, the medical therapy group had higher rates of distal occlusions (46% vs 17.2%, p = 0.001) and the IAT group had higher rates of vertebrobasilar occlusion (20.4% vs 40.6%, p = 0.02).
Conclusion: This study highlights good safety profile in patients undergoing IAT for strokes with minor symptoms. Favorable outcomes were observed in patients with successful recanalization, anterior circulation occlusions and tandem lesions. A randomized clinical trial is warranted to investigate the benefit of IAT in patients with low NIHSS over medical therapy alone and our findings can assist in patient selection.
Author Disclosures: H. Shoirah: None. A.R. Al-Bayati: None. C.L. Kenmuir: None. A. Aghaebrahim: None. T.G. Jovin: None. A.P. Jadhav: None.
- © 2016 by American Heart Association, Inc.