Introduction

Uncertainty regarding reperfusion of mildly-symptomatic (minor) large vessel occlusion (LVO)-strokes exists. Recently, benefits from reperfusion were suggested. However, there is still no strong data to support this. Furthermore, a proportion of those patients don't improve even after non-hemorrhagic reperfusion. Our study evaluated whether or not non-perfusion factors account for such persistent deconditioning.

Methods

Patients with identified minor LVO-strokes (NIHSS ≤ 8) from our stroke alert registry between January-2016 and May-2018 were included. Variables/ predictors of outcome were tested using univariate/multivariate logistic and linear regression analyses. Three month-modified ranking scale (mRS) was used to differentiate between favorable (mRS = 0-2) and unfavorable outcomes (mRS = 3–6).

Results

Eighty-one patients were included. Significant differences between the two outcome groups regarding admission-NIHSS and discharge-NIHSS existed (OR = 0.47, 0.49 / p = 0.0005, <0.0001 respectively).The two groups had matching perfusion measures. In the poor outcome group, discharge-NIHSS was unchanged from the admission-NIHSS while in the good outcome group, discharge-NIHSS significantly improved.

Conclusion

Admission and discharge NIHSS are independent predictors of outcome in patients with minor-LVO strokes. Unchanged discharge-NIHSS predicts worse outcomes while improved discharge-NIHSS predicts good outcomes. Unchanged NIHSS in the poor outcome group was independent of the perfusion parameters. In literature, complement activation and pro-inflammatory responses to ischemia might account for the progression of stroke symptoms in major-strokes. Our study concludes similar phenomena might be present in minor-strokes. Therefore, discharge-NIHSS may be useful as a clinical marker for future therapies.

中文翻译：

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非灌注因素在轻度症状性大血管阻塞性卒中中的作用。

介绍

存在关于轻度症状（次要）大血管闭塞（LVO）中风再灌注的不确定性。最近，有人建议从再灌注中获益。但是，仍然没有强大的数据来支持这一点。此外，即使非出血性再灌注后，这些患者中的一部分也没有改善。我们的研究评估了非灌注因素是否导致了这种持续性疾病。

方法

在我们的卒中预警登记系统中，于2016年1月至2018年5月期间发现了轻度LVO中风（NIHSS≤8）的患者。使用单变量/多变量对数和线性回归分析测试结果的变量/预测因子。使用三个月修订的排名量表（mRS）来区分有利（mRS = 0-2）和不利（mRS = 3-6）。

结果

包括八十一名患者。两组结果在入院-NIHSS和出院-NIHSS上存在显着差异（OR分别为0.47、0.49 / p = 0.0005，<0.0001）。在不良结局组中，出院-NIHSS与入院-NIHSS持平，而在好结局组中，出院-NIHSS明显改善。

结论

入院和出院NIHSS是轻度LVO中风患者预后的独立预测因子。不变的出院-NIHSS预测结果较差，而改善的出院-NIHSS预测结果良好。结果较差组的NIHSS不变，与灌注参数无关。在文献中，补体激活和对局部缺血的促炎反应可能是大卒中中风症状发展的原因。我们的研究得出的结论是，类似的现象可能会出现在小冲程中。因此，出院-NIHSS可用作将来治疗的临床指标。