Since you didn't measure outcome correctly, this was useless research. The only goal in stroke is 100% recovery!
Here is your business101 requirements.
The latest here:
Mechanical thrombectomy for mild stroke with anterior circulation large vessel occlusion: a multicenter cohort study
Gaopan Zhang
Neng Zhang1†
Xiongfei Zhao- 1Department of Neurology, Xianyang Hospital of Yan'an University, Xianyang, China
- 2Department of Neurosurgery, The First Hospital of Yulin and The Second Affiliated Hospital, Yan'an University, Yulin, China
- 3School of Clinical Medicine, Xi'an Medical University, Xi'an, China
Background: The clinical benefit of mechanical thrombectomy (MT) for anterior circulation emergency large vessel occlusion (ELVO) in patients presenting with a mild National Institutes of Health Stroke Scale score (<6) remains uncertain. We aimed to assess the efficacy and safety of MT in this patient population.
Methods: We enrolled individuals presenting with mild stroke attributable to anterior circulation LVO from three stroke centers between March 2020 and June 2024. The primary endpoint was an excellent 90-day outcome, defined as a modified Rankin Scale (mRS) score of 0–1.(But the way to measure outcome is to ask your patient; 'ARE YOU 100% RECOVERED?' That is the only outcome measure survivors are interested in!)Functional independence at day 90 (mRS 0–2) was considered the secondary endpoint. Safety endpoints consisted of symptomatic intracranial hemorrhage (sICH) and all-cause mortality within 90 days. Multivariable logistic regression with inverse probability of treatment weighting (IPTW) was applied to examine the association between MT and clinical outcomes.
Results: In total, 140 individuals with mELVO were selected for analysis, receiving either MT [n = 48; 35 males; mean age: 59.9 years; NIHSS median: 4 (IQR 2–5)] or medical management (MM) [n = 92; 62 males; mean age: 61.9 years; NIHSS median: 3 (IQR 1–4)]. No statistically significant differences were observed between the MT and MM groups in excellent outcome (aOR = 0.93; 95% CI, 0.41–2.11), functional independence (aOR = 2.14; 95% CI, 0.77–5.91), symptomatic intracranial hemorrhage (aOR = 1.63; 95% CI, 0.37–7.14), or mortality (aOR = 0.56; 95% CI, 0.02–20.94). The results remained consistent after IPTW adjustment.
Conclusion: Among patients with mELVO, MT was not associated with significantly different outcomes compared to MM. Further investigation through randomized controlled trials is warranted.
Introduction
Several randomized controlled studies have been demonstrated that mechanical thrombectomy (MT) leads to improved neurological outcomes in patients with anterior circulation emergency large vessel occlusion (ELVO), compared to medical management (MM) (1–4). As such, the American Heart Association (AHA) recommends that MT be considered the recommended treatment for anterior circulation ELVO and National Institutes of Health Stroke Scale (NIHSS) scores of at least 6 (5, 6). Patients with ELVO with a NIHSS < 6 (mELVO) were commonly excluded from these trials, with only three studies including a limited number of patients with mild neurological deficits (7–9).
As many as 10% of patients with ELVO demonstrate only minor stroke symptoms (10–12). Approximately 25% of patients with low-NIHSS ELVO stroke who received medical management did not achieve functional independence at 3 months (13). Only a small proportion of those receiving intravenous thrombolysis (IVT) achieved successful recanalization (14). A considerable number of patients with mild ELVO stroke may still experience poor clinical outcomes. Therefore, MT might offer greater functional benefit for individuals presenting with mild neurological symptoms.
Evidence supporting the clinical benefit and risks of MT in this specific subgroup remains limited. Therefore, we performed a multicenter retrospective study to assess the safety and efficacy outcomes of MT or MM in patients with mELVO.
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