Impact of recanalisation by mechanical thrombectomy in mild acute ischemic stroke with large anterior vessel occlusion - 08/10/21

Doi : 10.1016/j.neurol.2020.09.011

A. Karam ^a, B. Casolla ^a, M. Ferrigno ^a, J. Labreuche ^b, C. Cordonnier ^a, N. Bricout ^c, H. Henon ^a,⁎
^a Université de Lille, Inserm U1172, Department of Neurology, Stroke unit, CHU de Lille, Lille, France
^b Université de Lille, CHU de Lille, ULR 2694–METRICS: Évaluation des technologies de santé et des pratiques médicales, 59000 Lille, France
^c Interventional Neuroradiology, CHU de Lille, 59000 Lille, France

^⁎Corresponding author.

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Abstract

Background

The net clinical benefit of mechanical thrombectomy (MT) in patients presenting acute anterior circulation ischemic stroke with large-vessel occlusion (AIS–LVO) and mild neurological deficit is uncertain.

Aims

To investigate efficacy and safety of MT in patients with acute AIS–LVO and mild neurological deficit by evaluating i) the influence of recanalisation on three-month outcome and ii) mortality, symptomatic intracerebral hemorrhage (sICH) and procedural complications.

Methods

We included consecutive patients with acute AIS–LVO and National Institute of Stroke Scale (NIHSS) score<8, treated by MT at Lille University Hospital. Recanalisation was graded according to modified thrombolysis in cerebral infarction (mTICI) score, mTICI 2b/2c/3 being considered successful. We recorded procedural complications and classified intra-cerebral hemorrhages (ICH) and sICH according with European Cooperative Acute Stroke Study (ECASS) and ECASS2 criteria. Three-month outcome was evaluated by modified Rankin scale (mRS). Excellent and favourable outcomes were respectively defined as mRS 0–1 and 0–2 (or similar to pre-stroke).

Results

We included 95 patients. At three months, 56 patients (59. 0%) achieved an excellent outcome and 69 (72, 6%) a favourable outcome, both being more frequent in patients with successful recanalisation than in patients without (excellent outcome 71, 1% versus 10, 5%, P<0.001 and favourable outcome 82.9% versus 31.6%, P<0.001). The difference remained unchanged after adjustment for age and pre-MT infarct volume. Similar results were observed in patients with pre-MT NIHSS ≤5. Death occurred in five patients (5.3%), procedural complications in 12 (12.6%), any ICH in 38 (40.0%), including 3 (3.2%) sICH.