Background

Mechanical thrombectomy is now standard of care for treatment of acute ischemic stroke secondary to large vessel occlusion in the setting of high NIHSS. We analysed a large nationwide registry focusing on patients with large vessel occlusion and low NIHSS on admission to evaluate the efficacy and safety of thrombectomy in this patient population

Methods

2826 patients treated with mechanical thrombectomy were included in a multicentre registry from January 1, 2011 to December 31, 2015. We included patients with large vessel occlusion and NIHSS ≤ 6 on admission. Baseline characteristics, imaging, clinical outcome, procedure adverse events and positive and negative outcome predictors were analysed.

Results

134 patients were included. 90/134 had an anterior circulation and 44 a posterior circulation stroke. One patient died before treatment. Successful revascularization (mTICI 2b-3) was achieved in 73.7% (98/133) of the patients. Intraprocedural adverse event was observed in 3% (4/133) of cases. Symptomatic intracranial haemorrhage rate was 5.3% (7/133). At three months, 70.9% (95/134) of the patients had mRS score 0-2, 15.7% (21/134) mRS 3-5 and 13.4% (18/134) mRS 6. Age and successful recanalization were significant predictors of a good clinical outcome on both univariate (p= 0.005 and p=0.007) and multivariable (p=0.0018 and p=0.009 [nat log]) analysis. Absence of vessel recanalization and symptomatic intracranial hemorrhage were independent predictors of poor outcome (p=0.021) .

Conclusions

Our study suggests that patients with large vessel occlusion and low NIHSS score on admission can benefit from mechanical thrombectomy. Randomized trials are warranted.

中文翻译：

---

近端闭塞和低NIHSS患者的机械血栓切除术：来自大量前瞻性登记的结果。

背景

在高NIHSS的情况下，机械血栓切除术现已成为治疗因大血管闭塞继发的急性缺血性中风的护理标准。我们分析了一个全国性的大型注册中心，重点针对入院时大血管闭塞和低NIHSS的患者，以评估该患者人群中血栓切除术的疗效和安全性

方法

从2011年1月1日至2015年12月31日，在多中心注册表中纳入2826例接受机械血栓切除术治疗的患者。我们纳入了大血管闭塞且入院时NIHSS≤6的患者。分析基线特征，影像学，临床结局，手术不良事件以及阳性和阴性结局预测因子。

结果

包括134名患者。90/134发生前循环，44发生后循环中风。一名患者在治疗前死亡。73.7％（98/133）的患者获得了成功的血运重建（mTICI 2b-3）。在3％（4/133）的病例中观察到了术中不良事件。有症状的颅内出血率为5.3％（7/133）。在三个月的时间里，有70.9％（95/134）的患者mRS得分为0-2、15.7％（21/134）的mRS 3-5和13.4％（18/134）的mRS6。年龄和再通成功是重要的预测指标单变量（p = 0.005和p = 0.007）和多变量（p = 0.0018和p= 0.009 [nat log]）分析。缺乏血管再通和有症状的颅内出血是不良预后的独立预测因素（p = 0.021）。

结论

我们的研究表明，大血管闭塞和入院时NIHSS评分低的患者可以从机械血栓切除术中受益。随机试验是必要的。