PURPOSE Many stroke patients with large vessel occlusion present with a low National Institutes of Health Stroke Scale (NIHSS). There is currently no level 1A recommendation for endovascular treatment (EVT) for this patient subgroup. From a physician's standpoint, the deficits might only be slight, but they are often devastating from a patient perspective. Furthermore, early neurologic deterioration is common. The purpose of this study was to explore endovascular treatment attitudes of physicians in acute ischemic stroke patients presenting with low admission NIHSS. METHODS In an international cross-sectional survey among stroke physicians, participants were presented the scenario of a 76-year-old stroke patient with an admission NIHSS of 2. Survey participants were then asked how they would treat the patient (A) given their current local resources, and (B) under assumed ideal conditions, i.e., without external (monetary or infrastructural) constraints. Overall, country-specific and specialty-specific decision rates were calculated and clustered multivariable logistic regression performed to provide adjusted measures of effect size. RESULTS Two hundred seventy-five participants (150 neurologists, 84 interventional neuroradiologists, 30 neurosurgeons, 11 affiliated to other specialties) from 33 countries provided their treatment approach to this case scenario. Most physicians favored an endovascular treatment approach, either combined with intravenous alteplase (55.3% under assumed ideal and 52.0% under current working conditions) or as single treatment (11.3% under assumed ideal and 8.4% under current conditions). CONCLUSION Despite the limited evidence for endovascular therapy in acute stroke patients with low NIHSS, most physicians in this survey decided to proceed with endovascular therapy. A randomized controlled trial seems warranted.

中文翻译：

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美国国立卫生研究院卒中量表低，急性闭塞性大血管缺血性卒中患者的血管内治疗决策：来自国际多学科调查UNMASK EVT的见解。

目的许多具有大血管闭塞的卒中患者，其国立卫生研究院卒中量表（NIHSS）偏低。目前尚无针对该患者亚组的1A级血管内治疗（EVT）建议。从医师的角度来看，这些缺陷可能只是很小的，但从患者的角度来看，它们往往是毁灭性的。此外，早期神经系统恶化是常见的。这项研究的目的是探讨医师对低入院NIHSS的急性缺血性中风患者的血管内治疗态度。方法在一项针对卒中医师的国际横断面调查中，向参与者介绍了一名76岁卒中患者，其NIHSS为2。然后，调查参与者被问到他们将如何治疗患者（A）考虑到他们当前的本地资源，以及（B）在假定的理想条件下，即没有外部（货币或基础设施）约束。总体而言，计算了针对特定国家和特定行业的决策率，并进行了聚类多变量logistic回归以提供调整后的效应量度。结果来自33个国家的275名参与者（150名神经科医生，84名介入神经放射科医生，30名神经外科医生，11名其他专业的附属人员）为这种情况提供了治疗方法。大多数医生赞成采用静脉内阿替普酶联合治疗（假定理想状态为55.3％，在当前工作条件下为52.0％）或单独治疗（11。在理想条件下为3％，在当前条件下为8.4％）。结论尽管对于NIHSS低的急性卒中患者进行血管内治疗的证据有限，但本次调查中的大多数医生还是决定进行血管内治疗。似乎有必要进行一项随机对照试验。