Mild stroke: jury is still out on the best treatment approach

Takeaway

• Among patients with large-vessel occlusion stroke having only mild neurologic deficits, the evidence does not clearly favor mechanical thrombectomy over medical management or vice versa.

Why this matters

• The benefit of mechanical thrombectomy in this population is unknown.

 Key results

• In the study, vs best medical management, mechanical thrombectomy yielded:
  • Higher rate of asymptomatic intracranial hemorrhage (ICH; 17.5% vs 4.6%; P=.002).
  • Lower rate of functional independence (77.4% vs 88.5%; P=.02).
• No significant differences in other efficacy, safety outcomes.
• Mechanical thrombectomy conferred higher adjusted odds of asymptomatic ICH (OR, 11.07; P=.03).
• In the meta-analysis, association of mechanical thrombectomy with symptomatic ICH:
  • Significant in unadjusted analysis (OR, 5.52; P=.002).
  • Nonsignificant in adjusted analysis (OR, 2.06; P=.32).
• No independent associations found.

Study design

• International retrospective cohort study: 251 patients with large-vessel occlusion stroke having mild deficits (National Institutes of Health Stroke Scale score <6).
• Subsequent meta-analysis: 4 multicenter studies, 843 patients.
• Main outcomes were 3-month rates of:
  • Favorable functional outcome (modified Rankin Scale score 0-1).
  • Functional independence (modified Rankin Scale score 0-2).
  • Mortality, intracranial hemorrhage.
• Funding: None disclosed.

Limitations

• Lack of randomization.
• Residual confounding.
• Devices, reperfusion approaches for mechanical thrombectomy varied, selected by treating physicians.
• Self-reported outcomes.
• Limitations of scales used.