BACKGROUND AND PURPOSE Safety and efficacy of endovascular thrombectomy (EVT) in patients with mild stroke syndromes is unclear, especially in distal vessel occlusions. METHODS We analysed in our stroke database (HeiReKa) between 2002 and April 2019 safety and efficacy of EVT compared to intravenous thrombolysis (IVT) in patients with occlusions distal to the M1 segment of the middle cerebral artery and the top of the basilar artery who presented with a National Institute of Health Stroke Scale (NIHSS) below 6. Excellent (good) outcome was defined as modified rankin scale (mRS) 0-1 (0-2) or return to baseline mRS (good) after 3 months. Safety endpoints were mortality after 3 months and intracranial hemorrhage according to the Heidelberg Bleeding Classification (HBC). RESULTS Of 4167 patients 94 met the inclusion criteria. Sixty-four patients were allocated to the IVT group and 30 to the EVT group of which 15 also received IVT; three patients (4.6%) in the IVT group received rescue EVT. Baseline characteristics did not differ but more M2 occlusions were found in the EVT group (93.3% vs. 64.1%, p = 0.02). Intracranial bleeding occurred more often in EVT patients (HBC class 2: 13.3% vs. 1.6%, p = 0.01). Excellent and good outcome were not significantly different (75% vs. 70%, p = 0.65 and 87.5% vs. 73.3%, p = 0.14). Mortality was significantly lower in IVT patients (1.6% vs. 13.3%, p = 0.04). CONCLUSION Rates of excellent and good outcome after IVT or EVT were almost similar, but safety parameters were increased after EVT. EVT may be considered in selected patients after careful risk/benefit analysis.

中文翻译：

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轻度卒中患者的远端动脉闭塞-血管内治疗是否优于单独的溶栓治疗？

背景与目的目前尚不清楚轻度卒中综合征患者的血管内血栓切除术（EVT）的安全性和有效性，尤其是远端血管闭塞。方法我们在2002年至2019年4月的卒中数据库（HeiReKa）中分析了EVT与静脉溶栓（IVT）相比在大脑中动脉M1段和基底动脉顶部M1远端闭塞的患者的安全性和有效性美国国立卫生研究院卒中量表（NIHSS）低于6。优异（良好）结果定义为改良的兰肯量表（mRS）0-1（0-2）或3个月后恢复基线mRS（良好）。根据海德堡出血分类（HBC），安全性终点指标是3个月后的死亡率和颅内出血。结果4167名患者中有94名符合纳入标准。IVT组有64例患者，EVT组有30例，其中15例也接受了IVT。IVT组中的三名患者（4.6％）接受了紧急EVT。基线特征没有差异，但是在EVT组中发现了更多的M2闭塞（93.3％对64.1％，p = 0.02）。EVT患者的颅内出血发生率更高（HBC 2级：13.3％和1.6％，p = 0.01）。优秀和好结果没有显着差异（75％vs. 70％，p = 0.65和87.5％vs. 73.3％，p = 0.14）。IVT患者的死亡率显着降低（1.6％对13.3％，p = 0.04）。结论IVT或EVT后优良和良好结局发生率几乎相似，但EVT后安全性参数增加。经过仔细的风险/获益分析后，可以考虑在某些患者中考虑EVT。