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Safety and Outcome of Endovascular Treatment for Minor Ischemic Stroke: Results From the Multicenter Clinical Registry of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands

Goal: Insufficient data is available about safety and efficacy of endovascular treatment (EVT) in patients with minor stroke symptoms because these patients were excluded from most randomized trials. We aimed to compare characteristics, functional outcome, and complications in patients with minor is...

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Published in:Journal of stroke and cerebrovascular diseases 2019-03, Vol.28 (3), p.542-549
Main Authors: Goldhoorn, R.B., Mulder, Maxim J.H.L., Jansen, Ivo G.H., van Zwam, Wim H., Staals, Julie, van der Lugt, Aad, Dippel, Diederik W.J., Lingsma, Hester F., Vos, Jan Albert, Boiten, Jelis, van den Wijngaard, Ido R., Majoie, Charles B.L.M., Roos, Yvo B.W.E.M., van Oostenbrugge, Robert J.
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cited_by cdi_FETCH-LOGICAL-c464t-dae59f1ff66a907afe4946740f6bd6a80f4d4774b76a2ca38fb7d8ae45938bee3
cites cdi_FETCH-LOGICAL-c464t-dae59f1ff66a907afe4946740f6bd6a80f4d4774b76a2ca38fb7d8ae45938bee3
container_end_page 549
container_issue 3
container_start_page 542
container_title Journal of stroke and cerebrovascular diseases
container_volume 28
creator Goldhoorn, R.B.
Mulder, Maxim J.H.L.
Jansen, Ivo G.H.
van Zwam, Wim H.
Staals, Julie
van der Lugt, Aad
Dippel, Diederik W.J.
Lingsma, Hester F.
Vos, Jan Albert
Boiten, Jelis
van den Wijngaard, Ido R.
Majoie, Charles B.L.M.
Roos, Yvo B.W.E.M.
van Oostenbrugge, Robert J.
description Goal: Insufficient data is available about safety and efficacy of endovascular treatment (EVT) in patients with minor stroke symptoms because these patients were excluded from most randomized trials. We aimed to compare characteristics, functional outcome, and complications in patients with minor ischemic stroke National Institutes of Health Stroke Scale score ≤5 (NIHSS score ≤5) and moderate to severe ischemic stroke (NIHSS score ≥6) due to intracranial proximal artery occlusion of the anterior circulation who underwent EVT. Materials and Methods: We report patients with an anterior circulation occlusion who were included between March 2014 and June 2016 in the multicenter randomized clinical trial of EVT of acute ischemic stroke in the Netherlands Registry, a prospective, multicenter, observational study for stroke centers that perform EVT in the Netherlands. Minor ischemic stroke was defined as baseline NIHSS score of 5 or less. Primary outcome is the modified Rankin Scale (mRS) score at 90 days. Secondary outcomes include symptomatic intracranial hemorrhage (sICH) and mortality. Findings: Seventy-one (5.5%) patients had a NIHSS score of 5 or less. Functional independence (mRS 0-2 at 90 days) was reached in 75% of these patients, compared to 40% of patients with NIHSS score of 6 or more. sICH occurred in 4% of patients, of which 1% occurred peri-interventionally. Death occurred in 6% of patients. Conclusions: Patients with minor ischemic stroke with an intracranial proximal arterial occlusion of the anterior circulation who underwent EVT have a high chance of favorable outcome and appear to have low occurrence of treatment-related sICH. Therefore, our results encourage the use of EVT for minor ischemic stroke in the absence of effect estimates from controlled studies.
doi_str_mv 10.1016/j.jstrokecerebrovasdis.2018.10.029
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We aimed to compare characteristics, functional outcome, and complications in patients with minor ischemic stroke National Institutes of Health Stroke Scale score ≤5 (NIHSS score ≤5) and moderate to severe ischemic stroke (NIHSS score ≥6) due to intracranial proximal artery occlusion of the anterior circulation who underwent EVT. Materials and Methods: We report patients with an anterior circulation occlusion who were included between March 2014 and June 2016 in the multicenter randomized clinical trial of EVT of acute ischemic stroke in the Netherlands Registry, a prospective, multicenter, observational study for stroke centers that perform EVT in the Netherlands. Minor ischemic stroke was defined as baseline NIHSS score of 5 or less. Primary outcome is the modified Rankin Scale (mRS) score at 90 days. Secondary outcomes include symptomatic intracranial hemorrhage (sICH) and mortality. Findings: Seventy-one (5.5%) patients had a NIHSS score of 5 or less. Functional independence (mRS 0-2 at 90 days) was reached in 75% of these patients, compared to 40% of patients with NIHSS score of 6 or more. sICH occurred in 4% of patients, of which 1% occurred peri-interventionally. Death occurred in 6% of patients. Conclusions: Patients with minor ischemic stroke with an intracranial proximal arterial occlusion of the anterior circulation who underwent EVT have a high chance of favorable outcome and appear to have low occurrence of treatment-related sICH. Therefore, our results encourage the use of EVT for minor ischemic stroke in the absence of effect estimates from controlled studies.</description><identifier>ISSN: 1052-3057</identifier><identifier>EISSN: 1532-8511</identifier><identifier>DOI: 10.1016/j.jstrokecerebrovasdis.2018.10.029</identifier><identifier>PMID: 30527790</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>endovascular treatment ; Ischemic stroke ; large vessel oclusion ; minor symptoms</subject><ispartof>Journal of stroke and cerebrovascular diseases, 2019-03, Vol.28 (3), p.542-549</ispartof><rights>2018</rights><rights>Copyright © 2018. Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c464t-dae59f1ff66a907afe4946740f6bd6a80f4d4774b76a2ca38fb7d8ae45938bee3</citedby><cites>FETCH-LOGICAL-c464t-dae59f1ff66a907afe4946740f6bd6a80f4d4774b76a2ca38fb7d8ae45938bee3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30527790$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Goldhoorn, R.B.</creatorcontrib><creatorcontrib>Mulder, Maxim J.H.L.</creatorcontrib><creatorcontrib>Jansen, Ivo G.H.</creatorcontrib><creatorcontrib>van Zwam, Wim H.</creatorcontrib><creatorcontrib>Staals, Julie</creatorcontrib><creatorcontrib>van der Lugt, Aad</creatorcontrib><creatorcontrib>Dippel, Diederik W.J.</creatorcontrib><creatorcontrib>Lingsma, Hester F.</creatorcontrib><creatorcontrib>Vos, Jan Albert</creatorcontrib><creatorcontrib>Boiten, Jelis</creatorcontrib><creatorcontrib>van den Wijngaard, Ido R.</creatorcontrib><creatorcontrib>Majoie, Charles B.L.M.</creatorcontrib><creatorcontrib>Roos, Yvo B.W.E.M.</creatorcontrib><creatorcontrib>van Oostenbrugge, Robert J.</creatorcontrib><creatorcontrib>MR CLEAN Registry investigators</creatorcontrib><title>Safety and Outcome of Endovascular Treatment for Minor Ischemic Stroke: Results From the Multicenter Clinical Registry of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands</title><title>Journal of stroke and cerebrovascular diseases</title><addtitle>J Stroke Cerebrovasc Dis</addtitle><description>Goal: Insufficient data is available about safety and efficacy of endovascular treatment (EVT) in patients with minor stroke symptoms because these patients were excluded from most randomized trials. We aimed to compare characteristics, functional outcome, and complications in patients with minor ischemic stroke National Institutes of Health Stroke Scale score ≤5 (NIHSS score ≤5) and moderate to severe ischemic stroke (NIHSS score ≥6) due to intracranial proximal artery occlusion of the anterior circulation who underwent EVT. Materials and Methods: We report patients with an anterior circulation occlusion who were included between March 2014 and June 2016 in the multicenter randomized clinical trial of EVT of acute ischemic stroke in the Netherlands Registry, a prospective, multicenter, observational study for stroke centers that perform EVT in the Netherlands. Minor ischemic stroke was defined as baseline NIHSS score of 5 or less. Primary outcome is the modified Rankin Scale (mRS) score at 90 days. Secondary outcomes include symptomatic intracranial hemorrhage (sICH) and mortality. Findings: Seventy-one (5.5%) patients had a NIHSS score of 5 or less. Functional independence (mRS 0-2 at 90 days) was reached in 75% of these patients, compared to 40% of patients with NIHSS score of 6 or more. sICH occurred in 4% of patients, of which 1% occurred peri-interventionally. Death occurred in 6% of patients. Conclusions: Patients with minor ischemic stroke with an intracranial proximal arterial occlusion of the anterior circulation who underwent EVT have a high chance of favorable outcome and appear to have low occurrence of treatment-related sICH. 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subjects endovascular treatment
Ischemic stroke
large vessel oclusion
minor symptoms
title Safety and Outcome of Endovascular Treatment for Minor Ischemic Stroke: Results From the Multicenter Clinical Registry of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands
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