Thrombectomy or intravenous thrombolysis in patients with NIHSS of 5 or less?
J Neuroradiol
; 46(4): 225-230, 2019 Jul.
Article
em En
| MEDLINE
| ID: mdl-30659890
ABSTRACT
BACKGROUND AND PURPOSE:
To compare outcomes of minor stroke patients with intracranial vessel occlusions (IVO) underwent mechanical thrombectomy (MT) versus those treated with intravenous thrombolysis alone (IVT).METHODS:
We retrospectively reviewed two large prospective stroke databases from two European centers searching for patients admitted with minor stroke (i.e. NIHSS Scoreâ≤â5), baseline mRSâ=â0 and occlusion of the M1-M2 segment of the middle cerebral artery (MCA). Groups receiving (A) IVT alone and (B) MT+/-IVT were compared. Primary outcome measures were MT safety, successful recanalization rate (mTICI 2b-3) and NIHSS shift (discharge NIHSS minus admission NIHSS); secondary outcomes included discharge rates and excellent outcome (mRS 0-1) at 3 months. Univariate and multivariate analyses were performed.RESULTS:
Thirty-two patients were enrolled in Group B (19âMT alone; 13 MTâ+âIVT) and 24 in Group A. Successful recanalization (mTICI 2b-3) was obtained in 100% of cases in Group B vs 38% in Group A. Symptomatic hemorrhagic transformation rate did not differ between the two groups. Multivariate analysis reported MT as the only predictor of early (<â12âh) favorable NIHSS shift and lower NIHSS at discharge. Moreover, discharge at home and excellent outcome at 3-month follow-up were statistically associated with MT.CONCLUSIONS:
MT in patients with minor strokes and intracranial vessel occlusion (IVO) is safe and can determine a rapid improvement of NIHSS Score. MT seems also associated with a higher rate of patients discharged at home after hospitalization and better clinical outcome at 3-month follow-up. Larger randomized trials are warranted to confirm these results.
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Terapia Trombolítica
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Trombectomia
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Acidente Vascular Cerebral
Tipo de estudo:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
J Neuroradiol
Ano de publicação:
2019
Tipo de documento:
Article