Shashvat M Desai1, Marcelo Rocha1, Matthew Starr1, Bradley J Molyneaux1, Cynthia L Kenmuir1, Bradley A Gross1, Brian T Jankowitz1, Tudor G Jovin1, Ashutosh P Jadhav2. 1. University of Pittsburgh Medical Center, Departments of Neurology, Pittsburgh, Pennsylvania; University of Pittsburgh Medical Center, Departments of Neurosurgery, Pittsburgh, Pennsylvania. 2. University of Pittsburgh Medical Center, Departments of Neurology, Pittsburgh, Pennsylvania; University of Pittsburgh Medical Center, Departments of Neurosurgery, Pittsburgh, Pennsylvania. Electronic address: jadhavap@upmc.edu.
Abstract
OBJECTIVE: Endovascular thrombectomy (ET) for acute ischemic stroke (AIS) due to large-vessel occlusion (LVO) is offered to select patients meeting strict criteria. One of the criteria is stroke severity as indicated by the National Institute of Health Stroke Scale (NIHSS). Inherently, NIHSS is biased towards left hemisphere strokes (LHS) with median NIHSS score 4 points higher than right hemisphere strokes (RHS). This may potentially affect clinical decision making and thrombectomy eligibility. We sought to test this hypothesis. METHODS: Data were analyzed from consecutive AIS patients with LVO admitted to our comprehensive stroke center (June 2015-December 2016). Following variables were studied: NIHSS score, occlusion location, time to presentation, and treatment received. RESULTS: Three hundred and fifty-one proximal-anterior circulation LVOs (ACLVO) were identified. 211 patients harboring a proximal ACLVO, were treated <24-hour from symptom onset, had a baseline mRS 0-1, ASPECTS ≥6, and NIHSS score ≥6. One hundred and twelve (53%) were LHS and 99 (47%) were RHS. ET was performed in 87% of LHS and 78% of RHS (P = .09). In the NIHSS score >12 range, 88% of LHS and RHS received ET (P = .93). In the NIHSS score 6-12 range, 81% of LHS and 52% of RHS received ET (P = .03). CONCLUSIONS: We find comparable rates of ET between right and LHS in patients with high NIHSS but lower rates of ET of RHS than LHS in patients at lower NIHSS. A hemisphere-laterality based adjustment to the NIHSS may better identify the full extent of patients that may benefit from ET.
OBJECTIVE: Endovascular thrombectomy (ET) for acute ischemic stroke (AIS) due to large-vessel occlusion (LVO) is offered to select patients meeting strict criteria. One of the criteria is stroke severity as indicated by the National Institute of Health Stroke Scale (NIHSS). Inherently, NIHSS is biased towards left hemisphere strokes (LHS) with median NIHSS score 4 points higher than right hemisphere strokes (RHS). This may potentially affect clinical decision making and thrombectomy eligibility. We sought to test this hypothesis. METHODS: Data were analyzed from consecutive AISpatients with LVO admitted to our comprehensive stroke center (June 2015-December 2016). Following variables were studied: NIHSS score, occlusion location, time to presentation, and treatment received. RESULTS: Three hundred and fifty-one proximal-anterior circulation LVOs (ACLVO) were identified. 211 patients harboring a proximal ACLVO, were treated <24-hour from symptom onset, had a baseline mRS 0-1, ASPECTS ≥6, and NIHSS score ≥6. One hundred and twelve (53%) were LHS and 99 (47%) were RHS. ET was performed in 87% of LHS and 78% of RHS (P = .09). In the NIHSS score >12 range, 88% of LHS and RHS received ET (P = .93). In the NIHSS score 6-12 range, 81% of LHS and 52% of RHS received ET (P = .03). CONCLUSIONS: We find comparable rates of ET between right and LHS in patients with high NIHSS but lower rates of ET of RHS than LHS in patients at lower NIHSS. A hemisphere-laterality based adjustment to the NIHSS may better identify the full extent of patients that may benefit from ET.
Authors: Eva B Aamodt; Stian Lydersen; Dag Alnæs; Till Schellhorn; Ingvild Saltvedt; Mona K Beyer; Asta Håberg Journal: Front Neurol Date: 2022-06-03 Impact factor: 4.086
Authors: Anna Falanga; Avi Leader; Chiara Ambaglio; Zsuzsa Bagoly; Giancarlo Castaman; Ismail Elalamy; Ramon Lecumberri; Alexander Niessner; Ingrid Pabinger; Sebastian Szmit; Alice Trinchero; Hugo Ten Cate; Bianca Rocca Journal: Hemasphere Date: 2022-07-13