Mechanical Thrombectomy for Acute Stroke Due to Large-Vessel Occlusion Presenting With Mild Symptoms

Feifeng Liu, Hao Shen, Chen Chen, Huan Bao, Lian Zuo, Xiahong Xu, Yumei Yang, Alexia Cochrane, Yaping Xiao, Gang Li, Feifeng Liu, Hao Shen, Chen Chen, Huan Bao, Lian Zuo, Xiahong Xu, Yumei Yang, Alexia Cochrane, Yaping Xiao, Gang Li

Abstract

Purpose: To evaluate the safety and efficacy of mechanical thrombectomy (MT) for acute stroke due to large vessel occlusion (LVO), presenting with mild symptoms. Methods: A prospective cohort study of patients with mild ischemic stroke and LVO was conducted. Patients were divided into two groups: MT group or best medical management (MM) group. Propensity score matching (PSM) was conducted to reduce the confounding bias between the groups. The primary outcome was functional independence at 90 days. The safety outcome was symptomatic intracranial hemorrhage (sICH). Univariate and multivariate logistic regression analyses were used to identify the independent factors associated with outcomes. Results: Among the 105 included patients, 43 were in the MT group and 62 in the MM group. Forty-three pairs of patients were generated after PSM. There were no significant differences in sICH rates between two groups (p = 1.000). The MT group had a higher proportion of independent outcomes (83.7% MT vs. 67.4% MM; OR 2.483; 95% CI 0.886-6.959; p = 0.079) and excellent outcomes (76.7% MT vs. 51.2% MM; OR 3.150; 95% CI 1.247-7.954; p = 0.013) compared to the MM group, especially in patients with stroke of the anterior circulation (p < 0.05). Multivariate logistic regression analysis showed that small infarct core volume (p = 0.015) and MT treatment (p = 0.013) were independently associated with excellent outcomes. Conclusions: Our results suggest that MT in stroke patients, presenting with mild symptoms, due to acute LVO in the anterior circulation may be associated with satisfactory clinical outcomes. Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT04526756.

Keywords: acute large vessel occlusion; mild stroke; outcome; prognosis; thrombectomy.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Liu, Shen, Chen, Bao, Zuo, Xu, Yang, Cochrane, Xiao and Li.

Figures

Figure 1
Figure 1
The study flowchart. NIHSS, National Institutes of Health Stroke Scale; mRS, modified Rankin Scale; MT, mechanical thrombectomy; MM, medical management; LVO including middle cerebral artery M1, proximal M2 segment, intracranial internal carotid artery, basilar artery, and posterior cerebral artery P1 occlusion.

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