Abstract
Abstract TP26: Endovascular Therapy in Patients With Low NIHSS Score on Presentation
Stroke (1970), v 49(Suppl_1)
22 Jan 2018
Abstract
Abstract only
Introduction:
Approximately 2/3 of all AIS present with NIHSS 0-5. While it has been demonstrated that LVO can be found in ~10-20% of all low NIHSS patients, outcome data in this population remains scarce. Indeed, only 14/1766 patients in the recent endovascular RCTs had baseline (b) NIHSS in the 0-5 range. Yet, the presence of LVO in the setting of low NIHSS is associated with ~10-fold increase in subsequent deterioration. We aim to describe the outcomes in a large cohort of low NIHSS patients undergoing thrombectomy.
Methods:
Patients derived from a large prospective multicenter international stent-retriever registry (Trevo Registry, n=2,010). Baseline and outcome variables were compared according to bNIHSS 0-8 vs >8 and bNIHSS 0-5 vs >5. The primary and secondary efficacy endpoints were the rates of 90-day mRS 0-2 and mTICI 2b-3, respectively. Safety endpoints included sICH and 90-day mortality.
Results:
A total of 1,985 patients were included. As compared with patients with higher baseline NIHSS, low baseline NIHSS (0-8, n=342; 0-5, n=160) patients were younger, had less comorbidities and better functional status, more frequently had MCA-M2 or vertebrobasilar occlusions, less frequently received IV tpa, and underwent thrombectomy at later times (Table 1). The reperfusion outcomes were nearly the same. There were no significant differences in procedure-related complications, which were overall low (Table 2). The rates of 90-day mRS 0-2 were significantly higher in the lower NIHSS patients (p<0.001); however, ~20% of those patients were not independent and ~7% were dead at 90 days despite presenting with low clinical severity.
Conclusion:
Despite safe and efficacious endovascular reperfusion, low-NIHSS LVO patients have a relatively high proportion of bad outcomes. This supports the notion that many of "mildly" presenting patients do not fare well. A randomized clinical trial including immediate endovascular treatment in this patient population is warranted.
Metrics
5 Record Views
Details
- Title
- Abstract TP26: Endovascular Therapy in Patients With Low NIHSS Score on Presentation
- Creators
- Raul G Nogueira - Emory and Henry CollegeDiogo Haussen - Emory and Henry CollegeErol Veznedaroglu - Neurosciences InstituteRonald Budzik - OhioHealthRishi Gupta - WellStar Health SystemJonathan Grossberg - Emory and Henry CollegeClara M Barreira - Emory and Henry CollegeMehdi Bouslama - Emory and Henry CollegeJoey English - California Pacific Medical CenterBlaise Baxter - BaxterBruno Bartolini - Fondation Ophtalmologique Adolphe de RothschildMichael Frankel - Emory and Henry CollegeDavid Liebeskind - UCLA, Santa Monica, CATrevo Retriever Registry Investigators
- Publication Details
- Stroke (1970), v 49(Suppl_1)
- Resource Type
- Abstract
- Language
- English
- Academic Unit
- Neurosurgery
- Other Identifier
- 991021962292304721