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Clinical effect of successful reperfusion in patients presenting with NIHSS < 6 and large vessel occlusion
Yang Hu1, Shuhan Huang2, Gongbo Li1
1Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, No.74 Linjiang Road, Yuzhong District, Chongqing 400010, China.
Insights
Successful reperfusion significantly improves functional outcomes for patients with large vessel occlusion (LVO) and mild stroke symptoms. Achieving TICI 3 reperfusion, especially in middle cerebral artery occlusions without IVT, leads to excellent results.
Area of Science:
- Neurology
- Vascular Neurology
- Interventional Neurology
Background:
- Large vessel occlusion (LVO) in the anterior circulation can lead to significant disability.
- Patients with mild stroke severity (NIHSS < 6) may still benefit from reperfusion therapies.
- Evaluating the impact of reperfusion in this specific patient subgroup is crucial.
Purpose of the Study:
- To assess the effectiveness of reperfusion in patients with anterior circulation LVO and NIHSS scores less than 6.
- To determine the correlation between reperfusion grades and functional outcomes.
- To identify factors influencing outcomes in this patient population.
Main Methods:
- Retrospective cohort study design.
- Reperfusion grade assessed using the modified thrombolysis in cerebral infarction (TICI) score.
- Functional outcomes defined by modified Rankin Scale (mRS) scores at 3 months (mRS ≤1 for excellent, mRS ≤2 for favorable).
- Multivariate logistic regression analysis to evaluate outcomes, including mortality, hemorrhage, and complications.
Main Results:
- Seventy-six patients (86.4%) achieved successful reperfusion (TICI 2B/3).
- Excellent outcomes (mRS ≤1) were observed in 70.5% and favorable outcomes (mRS ≤2) in 78.4%.
- Higher TICI scores (TICI 3) were significantly associated with excellent outcomes (p < 0.05).
- Subgroup analyses revealed improved outcomes with TICI 3 in patients without intravenous thrombolysis (IVT) and with middle cerebral artery (MCA) occlusion.
Conclusions:
- Successful reperfusion is strongly linked to better functional outcomes in LVO patients with NIHSS < 6.
- TICI 3 reperfusion is particularly beneficial, especially for MCA occlusions and in patients not receiving IVT.
- These findings support aggressive reperfusion strategies in selected mild stroke patients.
Purpose:
The purpose of this study was to evaluate the impact of reperfusion in patients with large vessel occlusion (LVO) of the anterior circulation and National Institutes of Health Stroke Scale (NIHSS)< 6.
Methods:
It was a retrospective cohort study. The reperfusion grade was determined using the modified thrombolysis in cerebral infarction (TICI) score. The modified Rankin Score (mRS) ≤1 were defined as excellent and (mRS) ≤2 as favorable outcome at 3-month. Meanwhile, the all-cause mortality, intracerebral hemorrhage, and complications were recorded. Multivariate logistic regression analyses were performed to evaluate outcomes.
Results:
Seventy-six patients (86.4%) achieved reperfusion (TICI2B/3). Excellent outcome was achieved in 62 (70.5%) and favorable outcome in 69 (78.4%). All-cause death occurred in 2 (2.3%). The rate of excellent outcome in patients with TICI0,1,2A was 41.7%, with TICI2B 69.2%, and with TICI3 78.0% (p < 0.05). In a multivariate logistic regression analysis related to excellent outcome, the OR(95% CI) was 5.68(1.35,23.95) for TICI3; the test for linear trend by entering categorical variables as continuous variables in the adjusted model (p for trend=0.02<0.05), defining TICI0,1,2A as reference. Subgroup analyses showed without intravenous thrombolysis (IVT) (OR, 14.29; 95% CI, 1.76-116.37) and with middle cerebral artery (MCA) occlusion (OR, 7.97; 95% CI,1.26-50.32), the excellent outcome further improved with TICI3. Findings were similar in favorable outcome.
Conclusions:
Our results indicated that successful reperfusion was intensely connected with better functional outcomes for patients with LVO presenting with NIHSS<6 in the anterior circulation, especially MCA occlusion and pretreatment without IVT.
