X Shang1,2, M Lin3, S Zhang1,4, S Li5, Y Guo1,6, W Wang7, M Zhang8, Y Wan9, Z Zhou2, W Zi10, X Liu11,5. 1. From the Department of Neurology (X.S., S.Z., Y.G., X.L.), Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China. 2. Department of Neurology (X.S., Z.Z.), Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China. 3. Department of Neurology (M.L.), Fuzhou General Hospital of Nanjing Military Region, Fuzhou, Fujian, China. 4. Department of Neurology (S.Z.), Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China. 5. Department of Neurology (S.L., W.Z., X.L.), Jinling Hospital, Southern Medical University, Nanjing, Jiangsu, China. 6. Department of Neurology (Y.G.), Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, China. 7. Department of Radiology (W.W.), First People's Hospital of Yangzhou, Yangzhou University, Yangzhou, Jiangsu, China. 8. Department of Neurology (M.Z.), Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, China. 9. Department of Neurology (Y.W.), Hubei Zhongshan Hospital, Wuhan, Hubei, China. 10. Department of Neurology (S.L., W.Z., X.L.), Jinling Hospital, Southern Medical University, Nanjing, Jiangsu, China xfliu2@vip.163.com ziwenjie1981@163.com. 11. From the Department of Neurology (X.S., S.Z., Y.G., X.L.), Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China xfliu2@vip.163.com ziwenjie1981@163.com.
Abstract
BACKGROUND AND PURPOSE: Endovascular thrombectomy has been accepted as the standard of care for patients with acute ischemic stroke. Our aim was to investigate the clinical outcomes of patients with mild ischemic stroke with acute proximal large-vessel occlusion after endovascular treatment within 24 hours of symptom onset. MATERIALS AND METHODS: Between January 2014 and August 2017, ninety-three Chinese patients with mild ischemic stroke (NIHSS scores, 0-8) and large-vessel occlusion with endovascular treatment were retrospectively enrolled from 7 comprehensive stroke centers. They were divided into 2 groups: ≤6 hours and 6-24 hours from symptom onset to groin puncture. We analyzed their modified Rankin Scale scores at 90 days, symptomatic intracranial hemorrhage at 48 hours, and mortality during 90 days. Multivariable linear regression analysis was used to identify predictors for NIHSS shift after discharge. RESULTS: Twenty-nine patients received endovascular treatment within 6-24 hours after symptom onset and had an imaging mismatch based on perfusion CT or diffusion-weighted MR imaging. There were no substantial differences between the 2 groups in 90-day functional independence (P = .54) and the risks of the combination of symptomatic intracranial hemorrhage and death (P = .72). Two significant indicators of NIHSS shift were 48-hour symptomatic intracranial hemorrhage (unstandardized β = 7.28; 95% CI, 3.48-11.1; P < .001) and baseline systolic blood pressure (unstandardized β = 0.08; 95% CI, 0.03-0.14; P = .005). CONCLUSIONS: Patients with mild ischemic stroke and large-vessel occlusion in the anterior circulation, an imaging mismatch, and endovascular treatment within 6-24 hours of initial symptoms showed no heterogeneity in the efficacy and safety outcome compared with those treated ≤6 hours from symptom onset.
BACKGROUND AND PURPOSE: Endovascular thrombectomy has been accepted as the standard of care for patients with acute ischemic stroke. Our aim was to investigate the clinical outcomes of patients with mild ischemic stroke with acute proximal large-vessel occlusion after endovascular treatment within 24 hours of symptom onset. MATERIALS AND METHODS: Between January 2014 and August 2017, ninety-three Chinese patients with mild ischemic stroke (NIHSS scores, 0-8) and large-vessel occlusion with endovascular treatment were retrospectively enrolled from 7 comprehensive stroke centers. They were divided into 2 groups: ≤6 hours and 6-24 hours from symptom onset to groin puncture. We analyzed their modified Rankin Scale scores at 90 days, symptomatic intracranial hemorrhage at 48 hours, and mortality during 90 days. Multivariable linear regression analysis was used to identify predictors for NIHSS shift after discharge. RESULTS: Twenty-nine patients received endovascular treatment within 6-24 hours after symptom onset and had an imaging mismatch based on perfusion CT or diffusion-weighted MR imaging. There were no substantial differences between the 2 groups in 90-day functional independence (P = .54) and the risks of the combination of symptomatic intracranial hemorrhage and death (P = .72). Two significant indicators of NIHSS shift were 48-hour symptomatic intracranial hemorrhage (unstandardized β = 7.28; 95% CI, 3.48-11.1; P < .001) and baseline systolic blood pressure (unstandardized β = 0.08; 95% CI, 0.03-0.14; P = .005). CONCLUSIONS:Patients with mild ischemic stroke and large-vessel occlusion in the anterior circulation, an imaging mismatch, and endovascular treatment within 6-24 hours of initial symptoms showed no heterogeneity in the efficacy and safety outcome compared with those treated ≤6 hours from symptom onset.
Authors: Ondrej Volny; Charlotte Zerna; Ales Tomek; Michal Bar; Miloslav Rocek; Radek Padr; Filip Cihlar; Miroslava Nevsimalova; Lubomir Jurak; Roman Havlicek; Martin Kovar; Petr Sevcik; Vladimir Rohan; Jan Fiksa; David Cernik; Rene Jura; Daniel Vaclavik; Petra Cimflova; Josep Puig; Dar Dowlatshahi; Alexander V Khaw; Enrico Fainardi; Mohamed Najm; Andrew M Demchuk; Bijoy K Menon; Robert Mikulik; Michael D Hill Journal: Neurology Date: 2020-09-28 Impact factor: 9.910