Abstract
Objectives Current guidelines recommend Endovascular Thrombectomy (EVT) for patients with strokes with large vessel occlusion (LVO) and NIHSS≥6, and thrombolysis for patients with NIHSS≥4 and in mild strokes with disabling symptoms.1–3 Patients with LVO and NIHSS≤6 are considered mild, yet 1 in 4 patients can deteriorate neurologically, miss out on hyperacute reperfusion therapies and have poor outcomes.4 5
The aim is to compare neurological outcomes in patients with strokes with LVO and NIHSS≤6 who present within 24 hours of symptom onset to hospital, and who receive EVT with or without thrombolysis, thrombolysis alone, and no hyperacute therapy.
Methods This was a retrospective review of patients admitted to the Princess Alexandra Hospital’s Stroke Unit between July 2018 and April 2021 with initial NIHSS<6. Data included NIHSS (arrival, 24 hours post-admission, discharge and Day 90), and Day 90 mRS. Data was collected and analysed with Microsoft Excel 2019 and IBM SPSS Statistics 27 by Chi-Square analysis.
Results 85 patients were included. 17 received EVT with or without lysis, 23 received lysis alone, and 45 received no hyperacute therapy. There was no difference in rates of clinical deterioration (NIHSS increase ≥4) in 24 hours (p=0.19), on discharge (p=0.37) and by Day 90 (p=0.63).6–8 There was no difference in rates of good (mRS<3) and excellent (mRS<2) outcomes by Day 90 (p=0.38 and p=0.34 respectively).6–8
Conclusions In mild strokes, there was no significant difference in neurological deterioration by 24 hours, discharge, and Day 90, and no difference in Day 90 mRS in all treatment groups.
References
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