BACKGROUND The minimal stroke severity justifying endovascular intervention remains elusive. However, a significant proportion of patients presenting with large vessel occlusion stroke (LVOS) and mild symptoms go untreated and face poor outcomes. We aimed to evaluate the clinical outcomes of patients presenting with LVOS and low symptom scores (National Institutes of Health Stroke Scale [NIHSS] score ≤8) undergoing endovascular therapy (ET). METHODS We performed a retrospective analysis of a prospectively collected ET database between September 2010 and March 2016. Endovascularly treated patients with LVOS and a baseline NIHSS score ≤8 were included. Baseline patient characteristics, procedural details, and outcome parameters were collected. Efficacy outcomes were the rate of good outcome (90-day modified Rankin Scale score 0-2) and of successful reperfusion (modified Treatment in Cerebral Infarction [mTICI] score 2b-3). Safety was assessed by the rate of parenchymal hematoma (parenchymal hematoma type 1 [PH-1] and parenchymal hematoma type 2 [PH-2]) and 90-day mortality. Logistic regression was used to identify predictors of good clinical outcomes. RESULTS A total of 935 patients were considered; 72 patients with an NIHSS score ≤8 were included. Median [IQR] age was 61.5 years [56.2-73.0]; 39 patients (54%) were men. Mean (SD) baseline NIHSS score, computed tomography perfusion core volume, and ASPECTS were 6.3 (1.5), 7.5 mL (16.1), and 8.5 (1.3), respectively. Twenty-eight patients (39%) received intravenous tissue plasminogen activator. Occlusions locations were as follows: 29 (40%) proximal MCA-M1, 20 (28%) MCA-M2, 6 (8%) ICA terminus, and 9 (13%) vertebrobasilar. Tandem occlusion was documented in 7 patients (10%). Sixty-seven patients (93%) achieved successful reperfusion (mTICI score 2b-3); 52 (72%) had good 90-day outcomes. Mean final infarct volume was 32.2 ± 59.9 mL. Parenchymal hematoma occurred in 4 patients (6%). Ninety-day mortality was 10% (n = 7). Logistic regression showed that only successful reperfusion (OR 27.7, 95% CI 1.1-655.5, p = 0.04) was an independent predictor of good outcomes. CONCLUSION Our findings demonstrate that ET is safe and feasible for LVOS patients presenting with mild clinical syndromes. Future controlled studies are warranted.

中文翻译：

---

急性大血管闭塞中风和轻度临床症状患者血管内治疗的临床和影像学结果。

背景 证​​明血管内干预的最小卒中严重程度仍然难以捉摸。然而，有很大一部分患有大血管闭塞性卒中 (LVOS) 和轻度症状的患者未经治疗且预后不佳。我们旨在评估接受血管内治疗 (ET) 的 LVOS 和低症状评分（美国国立卫生研究院卒中量表 [NIHSS] 评分≤8）患者的临床结果。方法 我们对 2010 年 9 月至 2016 年 3 月期间前瞻性收集的 ET 数据库进行了回顾性分析。纳入了 LVOS 且基线 NIHSS 评分≤8 的血管内治疗患者。收集基线患者特征、程序细节和结果参数。疗效结局是良好结局率（90 天改良 Rankin 量表评分 0-2）和成功再灌注率（改良脑梗死治疗 [mTICI] 评分 2b-3）。通过实质血肿（1 型实质血肿 [PH-1] 和 2 型实质血肿 [PH-2]）和 90 天死亡率评估安全性。逻辑回归用于确定良好临床结果的预测因子。结果 总共考虑了 935 名患者；纳入 72 名 NIHSS 评分≤8 的患者。中位 [IQR] 年龄为 61.5 岁 [56.2-73.0]；39 名患者 (54%) 为男性。平均 (SD) 基线 NIHSS 评分、计算机断层扫描灌注核心体积和 ASPECTS 分别为 6.3 (1.5)、7.5 mL (16.1) 和 8.5 (1.3)。28 名患者 (39%) 接受了静脉内组织纤溶酶原激活剂。遮挡位置如下：29 (40%) MCA-M1 近端、20 (28%) MCA-M2、6 (8%) ICA 末端和 9 (13%) 椎基底动脉。7 名患者 (10%) 记录了串联闭塞。67 名患者 (93%) 成功再灌注（mTICI 评分 2b-3）；52 人 (72%) 的 90 天结果良好。平均最终梗死体积为 32.2 ± 59.9 mL。4名患者（6%）出现实质血肿。90 天死亡率为 10%（n = 7）。Logistic 回归表明，只有成功的再灌注（OR 27.7，95% CI 1.1-655.5，p = 0.04）是良好结果的独立预测因素。结论 我们的研究结果表明，ET 对表现为轻度临床综合征的 LVOS 患者是安全可行的。未来的对照研究是必要的。67 名患者 (93%) 成功再灌注（mTICI 评分 2b-3）；52 人 (72%) 的 90 天结果良好。平均最终梗死体积为 32.2 ± 59.9 mL。4名患者（6%）出现实质血肿。90 天死亡率为 10%（n = 7）。Logistic 回归表明，只有成功的再灌注（OR 27.7，95% CI 1.1-655.5，p = 0.04）是良好结果的独立预测因素。结论 我们的研究结果表明，ET 对表现为轻度临床综合征的 LVOS 患者是安全可行的。未来的对照研究是必要的。67 名患者 (93%) 成功再灌注（mTICI 评分 2b-3）；52 人 (72%) 的 90 天结果良好。平均最终梗死体积为 32.2 ± 59.9 mL。4名患者（6%）出现实质血肿。90 天死亡率为 10%（n = 7）。Logistic 回归表明，只有成功的再灌注（OR 27.7，95% CI 1.1-655.5，p = 0.04）是良好结果的独立预测因素。结论 我们的研究结果表明，ET 对表现为轻度临床综合征的 LVOS 患者是安全可行的。未来的对照研究是必要的。7, 95% CI 1.1-655.5, p = 0.04) 是良好结果的独立预测指标。结论 我们的研究结果表明，ET 对表现为轻度临床综合征的 LVOS 患者是安全可行的。未来的对照研究是必要的。7, 95% CI 1.1-655.5, p = 0.04) 是良好结果的独立预测指标。结论 我们的研究结果表明，ET 对表现为轻度临床综合征的 LVOS 患者是安全可行的。未来的对照研究是必要的。