Abstract
Objective: The objective of this study was to report on patient outcomes in a mAIS population who received IAT.
Background: Despite suffering mild acute ischemic strokes (mAIS, NIHSS≤7), patients have a non-zero risk of morbidity and mortality. Intra-arterial therapy (IAT) is clearly effective in moderate-to-severe AISs, but we have limited knowledge about its efficacy in mAISs.
Design/Methods: We included all adults (≥18) with a mAIS admitted over 6.5 years to a high-volume comprehensive stroke center and who received IAT. Patients were excluded for any contraindication to IAT (n=240). Outcomes were symptomatic ICH (sICH), in-hospital mortality, discharge mRS ≤2, and an improvement in NIHSS at discharge (>2 vs ≤2).
Results: There were 55 patients included in the study. Overall, patients were predominately aged 55–79 years, admitted with an NIHSS 4–7, or had hypertension. 72% of patients either had a cardioembolic or large vessel occlusion (LVO), and 73% arrived either 0h to 4.5h, or >6h to <12h from symptom onset. 15 patients also received IV-tPA. There were no sICHs. Mortality was 9%; a majority of deaths were in males, patients with ages 55–79, LVOs, or an early symptom to arrival time. 42% of patients showed a 3-point improvement in NIHSS at discharge; a majority of these patients were white, aged 55–79, or had hyperlipidemia. Ultimately, 45% were discharged with an mRS ≥2. There were no cerebral artery perforations or groin complications.
Conclusions: These data highlight the safety of IAT in patients with mAIS, mirroring the results seen in recent large RCTs in the non-mAIS population. Patients in our study had a zero risk of sICH, and a mortality rate similar to literature examining IV-tPA administration in patients with mAIS. Furthermore, a large proportion of patients showed a clinically meaningful improvement in NIHSS, or were discharged with a favorable mRS.
Disclosure: Dr. Fanale has nothing to disclose. Dr. Orlando has nothing to disclose. Dr. Frei has received personal compensation for activities with Microvention, Covidien, Stryker, Siemens and Penumbra as a consultant. Dr. Bellon has received personal compensation for activities with Penumbra. Dr. Wagner has received personal compensation for activities with Genentech as a speaker. Dr. Jensen has nothing to disclose. Dr. Bartt has nothing to disclose. Dr. van Vliet has nothing to disclose. Dr. McCarthy has nothing to disclose. Dr. Bar-Or has nothing to disclose.
Disputes & Debates: Rapid online correspondence
REQUIREMENTS
If you are uploading a letter concerning an article:
You must have updated your disclosures within six months: http://submit.neurology.org
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.