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Research paper
Outcome of patients with occlusions of the internal carotid artery or the main stem of the middle cerebral artery with NIHSS score of less than 5: comparison between thrombolysed and non-thrombolysed patients
  1. Mirjam R Heldner1,
  2. Simon Jung1,2,
  3. Christoph Zubler2,
  4. Pasquale Mordasini2,
  5. Anja Weck1,
  6. Marie-Luise Mono1,
  7. Christoph Ozdoba2,
  8. Marwan El-Koussy2,
  9. Heinrich P Mattle1,
  10. Gerhard Schroth2,
  11. Jan Gralla2,
  12. Marcel Arnold1,
  13. Urs Fischer1
  1. 1Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
  2. 2Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
  1. Correspondence to Professor Jan Gralla, Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Freiburgstrasse 10, CH-3010 Bern, Switzerland jan.gralla{at}insel.ch

Abstract

Background and purpose The use of thrombolysis in patients with minor neurological deficits and large vessel occlusion is controversial.

Methods We compared the outcome of patients with low National Institutes of Health Stroke Scale (NIHSS) scores and large vessel occlusions between thrombolysed and non-thrombolysed patients.

Results 88 (1.7%) of 5312 consecutive patients with acute (within 24 h) ischaemic stroke had occlusions of the internal carotid or the main stem of the middle cerebral artery and baseline NIHSS scores ≤5.47 (53.4%) were treated without thrombolysis, and 41 (46.6%) received intravenous thrombolysis, endovascular therapy or both. Successful recanalisation on MR or CT angiography at 24 h was more often observed in thrombolysed than in non-thrombolysed patients (78.9% versus 10.5%; p<0.001). Neurological deterioration (increase of NIHSS score ≥1 compared to baseline) was observed in 22.7% of non-thrombolysed versus 10.3% of thrombolysed after 24 h (p=0.002), in 33.3% versus 12.5% at hospital discharge (p=0.015) and in 41.4% versus 15% at 3 months (p<0.001). Symptomatic intracerebral haemorrhage occurred in two (asymptomatic in five) thrombolysed and in none (asymptomatic in three) non-thrombolysed. Thrombolysis was an independent predictor of favourable outcome (p=0.030) but not survival (p=0.606) at 3 months.

Conclusions Non-thrombolysed patients with mild deficits and large vessel occlusion deteriorated significantly more often within 3 months than thrombolysed patients. Symptomatic intracerebral haemorrhages occurred in less than 5% of patients in both groups. These data suggest that thrombolysis is safe and effective in these patients. Therefore, randomised trials in patients with large vessel occlusions and mild or rapidly improving symptoms are needed.

  • CEREBROVASCULAR DISEASE
  • SCALES
  • STROKE

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