BACKGROUND Prospective evidence to support mechanical thrombectomy (MT) for mild ischemic stroke with large vessel occlusion (LVO) is lacking. There is uncertainty about using an invasive procedure in patients with mild symptoms. OBJECTIVE To evaluate the safety and feasibility of MT in patients with mild symptoms and LVO. METHODS Our single-arm prospective pilot study recruited patients with LVO and initial National Institute of Health Stroke Scale (NIHSS) <6, who underwent standard MT. Primary safety endpoints were symptomatic intracerebral hemorrhage (sICH), and/or worsening NIHSS by ≥4 points. Secondary endpoints included angiographic recanalization, NIHSS change, final infarct volume, and modified Rankin score (mRS). RESULTS We enrolled 20 patients (mean age 65.6 ± 12.3 yr; 45% females). Thrombolysis in Cerebral Ischemia 2B/3 thrombectomy was achieved in 95%. No patients suffered sICH. One patient (5%) had neurologic worsening within 24 h because of underlying intracranial stenosis. No other complications or safety concerns were identified. Median NIHSS was significantly better at discharge (0.5, P = .007) and at last follow-up (0, P < .001) than before treatment (3). Mean post vs preintervention infarct volumes were small without significant difference (1.2 ml, P = .434). Most patients (85%) were discharged directly home. Excellent clinical outcome (mRS 0-1) at last follow-up was seen in 95% of patients. CONCLUSION This is one of the first specifically designed prospective studies showing that MT is safe and feasible in patients with low NIHSS and LVO. Chronic underlying vasculopathy may be a challenging dilemma. We observed excellent clinical and radiographic outcomes, but randomized controlled trials are needed to demonstrate the efficacy of MT in this unique cohort.

中文翻译：

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机械取栓治疗轻度急性缺血性卒中伴大血管闭塞的安全性和可行性

背景 缺乏支持机械取栓 (MT) 治疗伴有大血管闭塞 (LVO) 的轻度缺血性卒中的前瞻性证据。在症状较轻的患者中使用侵入性手术存在不确定性。目的评价轻度症状和LVO患者MT的安全性和可行性。方法 我们的单臂前瞻性试点研究招募了 LVO 和初始美国国立卫生研究院卒中量表 (NIHSS) <6 的患者，这些患者接受了标准 MT。主要安全终点是症状性脑出血 (sICH) 和/或 NIHSS 恶化≥4 分。次要终点包括血管造影再通、NIHSS 变化、最终梗死体积和改良 Rankin 评分 (mRS)。结果 我们招募了 20 名患者（平均年龄 65.6 ± 12.3 岁；45% 为女性）。脑缺血 2B/3 血栓切除术中的血栓溶解率为 95%。没有患者遭受 sICH。由于潜在的颅内狭窄，一名患者 (5%) 在 24 小时内出现神经系统恶化。没有发现其他并发症或安全问题。出院时 (0.5, P = .007) 和末次随访 (0, P < .001) 的 NIHSS 中位数显着优于治疗前 (3)。平均干预后与干预前梗死体积较小，无显着差异（1.2 ml，P = .434）。大多数患者（85%）直接出院回家。95% 的患者在最后一次随访时获得了优异的临床结果 (mRS 0-1)。结论 这是首批专门设计的前瞻性研究之一，表明 MT 在 NIHSS 和 LVO 低的患者中是安全可行的。慢性潜在血管病变可能是一个具有挑战性的困境。