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October 22, 2019; 93 (17) Article

Outcome of endovascular therapy in stroke with large vessel occlusion and mild symptoms

Concetta Manno, Giulio Disanto, Giovanni Bianco, View ORCID ProfileStefania Nannoni, View ORCID ProfileMirjam Heldner, Simon Jung, Marcel Arnold, Johannes Kaesmacher, Mandy Müller, View ORCID ProfileSebastian Thilemann, Henrik Gensicke, Emmanuel Carrera, Urs Fischer, Timo Kahles, Andreas Luft, Krassen Nedeltchev, Claudio Staedler, Alessandro Cianfoni, Georg Kägi, Leo H. Bonati, Patrik Michel, View ORCID ProfileCarlo W. Cereda
First published October 7, 2019, DOI: https://doi.org/10.1212/WNL.0000000000008362
Concetta Manno
From the Stroke Center (C.M., G.D., G.B., C.S., A.C., C.W.C.), Neurocenter of Southern Switzerland, Lugano; Stroke Center and Neurology Service (S.N., P.M., C.W.C.), Department of Clinical Neurosciences, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois); Department of Neurology (M.H., S.J., M.A., U.F.) and Institute of Diagnostic and Interventional Neuroradiology (A.C., J.K.), Institute of Diagnostic, Interventional and Pediatric Radiology, and Department of Neurology, University Hospital Bern and University of Bern, Inselspital; Department of Neurology and Stroke Center (M.M., S.T., H.G., L.H.B.), University Hospital of Basel; Stroke Center (E.C.), Service de Neurologie, HUG, Geneva; Department of Neurology (T.K., K.N.), Cantonal Hospital Aarau; Stroke Center (A.L.), Department of Neurology, University Hospital of Zürich; and Stroke Center (G.K.), Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland.
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Giulio Disanto
From the Stroke Center (C.M., G.D., G.B., C.S., A.C., C.W.C.), Neurocenter of Southern Switzerland, Lugano; Stroke Center and Neurology Service (S.N., P.M., C.W.C.), Department of Clinical Neurosciences, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois); Department of Neurology (M.H., S.J., M.A., U.F.) and Institute of Diagnostic and Interventional Neuroradiology (A.C., J.K.), Institute of Diagnostic, Interventional and Pediatric Radiology, and Department of Neurology, University Hospital Bern and University of Bern, Inselspital; Department of Neurology and Stroke Center (M.M., S.T., H.G., L.H.B.), University Hospital of Basel; Stroke Center (E.C.), Service de Neurologie, HUG, Geneva; Department of Neurology (T.K., K.N.), Cantonal Hospital Aarau; Stroke Center (A.L.), Department of Neurology, University Hospital of Zürich; and Stroke Center (G.K.), Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland.
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Giovanni Bianco
From the Stroke Center (C.M., G.D., G.B., C.S., A.C., C.W.C.), Neurocenter of Southern Switzerland, Lugano; Stroke Center and Neurology Service (S.N., P.M., C.W.C.), Department of Clinical Neurosciences, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois); Department of Neurology (M.H., S.J., M.A., U.F.) and Institute of Diagnostic and Interventional Neuroradiology (A.C., J.K.), Institute of Diagnostic, Interventional and Pediatric Radiology, and Department of Neurology, University Hospital Bern and University of Bern, Inselspital; Department of Neurology and Stroke Center (M.M., S.T., H.G., L.H.B.), University Hospital of Basel; Stroke Center (E.C.), Service de Neurologie, HUG, Geneva; Department of Neurology (T.K., K.N.), Cantonal Hospital Aarau; Stroke Center (A.L.), Department of Neurology, University Hospital of Zürich; and Stroke Center (G.K.), Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland.
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Stefania Nannoni
From the Stroke Center (C.M., G.D., G.B., C.S., A.C., C.W.C.), Neurocenter of Southern Switzerland, Lugano; Stroke Center and Neurology Service (S.N., P.M., C.W.C.), Department of Clinical Neurosciences, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois); Department of Neurology (M.H., S.J., M.A., U.F.) and Institute of Diagnostic and Interventional Neuroradiology (A.C., J.K.), Institute of Diagnostic, Interventional and Pediatric Radiology, and Department of Neurology, University Hospital Bern and University of Bern, Inselspital; Department of Neurology and Stroke Center (M.M., S.T., H.G., L.H.B.), University Hospital of Basel; Stroke Center (E.C.), Service de Neurologie, HUG, Geneva; Department of Neurology (T.K., K.N.), Cantonal Hospital Aarau; Stroke Center (A.L.), Department of Neurology, University Hospital of Zürich; and Stroke Center (G.K.), Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland.
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Mirjam Heldner
From the Stroke Center (C.M., G.D., G.B., C.S., A.C., C.W.C.), Neurocenter of Southern Switzerland, Lugano; Stroke Center and Neurology Service (S.N., P.M., C.W.C.), Department of Clinical Neurosciences, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois); Department of Neurology (M.H., S.J., M.A., U.F.) and Institute of Diagnostic and Interventional Neuroradiology (A.C., J.K.), Institute of Diagnostic, Interventional and Pediatric Radiology, and Department of Neurology, University Hospital Bern and University of Bern, Inselspital; Department of Neurology and Stroke Center (M.M., S.T., H.G., L.H.B.), University Hospital of Basel; Stroke Center (E.C.), Service de Neurologie, HUG, Geneva; Department of Neurology (T.K., K.N.), Cantonal Hospital Aarau; Stroke Center (A.L.), Department of Neurology, University Hospital of Zürich; and Stroke Center (G.K.), Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland.
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Simon Jung
From the Stroke Center (C.M., G.D., G.B., C.S., A.C., C.W.C.), Neurocenter of Southern Switzerland, Lugano; Stroke Center and Neurology Service (S.N., P.M., C.W.C.), Department of Clinical Neurosciences, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois); Department of Neurology (M.H., S.J., M.A., U.F.) and Institute of Diagnostic and Interventional Neuroradiology (A.C., J.K.), Institute of Diagnostic, Interventional and Pediatric Radiology, and Department of Neurology, University Hospital Bern and University of Bern, Inselspital; Department of Neurology and Stroke Center (M.M., S.T., H.G., L.H.B.), University Hospital of Basel; Stroke Center (E.C.), Service de Neurologie, HUG, Geneva; Department of Neurology (T.K., K.N.), Cantonal Hospital Aarau; Stroke Center (A.L.), Department of Neurology, University Hospital of Zürich; and Stroke Center (G.K.), Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland.
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Marcel Arnold
From the Stroke Center (C.M., G.D., G.B., C.S., A.C., C.W.C.), Neurocenter of Southern Switzerland, Lugano; Stroke Center and Neurology Service (S.N., P.M., C.W.C.), Department of Clinical Neurosciences, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois); Department of Neurology (M.H., S.J., M.A., U.F.) and Institute of Diagnostic and Interventional Neuroradiology (A.C., J.K.), Institute of Diagnostic, Interventional and Pediatric Radiology, and Department of Neurology, University Hospital Bern and University of Bern, Inselspital; Department of Neurology and Stroke Center (M.M., S.T., H.G., L.H.B.), University Hospital of Basel; Stroke Center (E.C.), Service de Neurologie, HUG, Geneva; Department of Neurology (T.K., K.N.), Cantonal Hospital Aarau; Stroke Center (A.L.), Department of Neurology, University Hospital of Zürich; and Stroke Center (G.K.), Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland.
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Johannes Kaesmacher
From the Stroke Center (C.M., G.D., G.B., C.S., A.C., C.W.C.), Neurocenter of Southern Switzerland, Lugano; Stroke Center and Neurology Service (S.N., P.M., C.W.C.), Department of Clinical Neurosciences, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois); Department of Neurology (M.H., S.J., M.A., U.F.) and Institute of Diagnostic and Interventional Neuroradiology (A.C., J.K.), Institute of Diagnostic, Interventional and Pediatric Radiology, and Department of Neurology, University Hospital Bern and University of Bern, Inselspital; Department of Neurology and Stroke Center (M.M., S.T., H.G., L.H.B.), University Hospital of Basel; Stroke Center (E.C.), Service de Neurologie, HUG, Geneva; Department of Neurology (T.K., K.N.), Cantonal Hospital Aarau; Stroke Center (A.L.), Department of Neurology, University Hospital of Zürich; and Stroke Center (G.K.), Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland.
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Mandy Müller
From the Stroke Center (C.M., G.D., G.B., C.S., A.C., C.W.C.), Neurocenter of Southern Switzerland, Lugano; Stroke Center and Neurology Service (S.N., P.M., C.W.C.), Department of Clinical Neurosciences, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois); Department of Neurology (M.H., S.J., M.A., U.F.) and Institute of Diagnostic and Interventional Neuroradiology (A.C., J.K.), Institute of Diagnostic, Interventional and Pediatric Radiology, and Department of Neurology, University Hospital Bern and University of Bern, Inselspital; Department of Neurology and Stroke Center (M.M., S.T., H.G., L.H.B.), University Hospital of Basel; Stroke Center (E.C.), Service de Neurologie, HUG, Geneva; Department of Neurology (T.K., K.N.), Cantonal Hospital Aarau; Stroke Center (A.L.), Department of Neurology, University Hospital of Zürich; and Stroke Center (G.K.), Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland.
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Sebastian Thilemann
From the Stroke Center (C.M., G.D., G.B., C.S., A.C., C.W.C.), Neurocenter of Southern Switzerland, Lugano; Stroke Center and Neurology Service (S.N., P.M., C.W.C.), Department of Clinical Neurosciences, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois); Department of Neurology (M.H., S.J., M.A., U.F.) and Institute of Diagnostic and Interventional Neuroradiology (A.C., J.K.), Institute of Diagnostic, Interventional and Pediatric Radiology, and Department of Neurology, University Hospital Bern and University of Bern, Inselspital; Department of Neurology and Stroke Center (M.M., S.T., H.G., L.H.B.), University Hospital of Basel; Stroke Center (E.C.), Service de Neurologie, HUG, Geneva; Department of Neurology (T.K., K.N.), Cantonal Hospital Aarau; Stroke Center (A.L.), Department of Neurology, University Hospital of Zürich; and Stroke Center (G.K.), Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland.
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Henrik Gensicke
From the Stroke Center (C.M., G.D., G.B., C.S., A.C., C.W.C.), Neurocenter of Southern Switzerland, Lugano; Stroke Center and Neurology Service (S.N., P.M., C.W.C.), Department of Clinical Neurosciences, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois); Department of Neurology (M.H., S.J., M.A., U.F.) and Institute of Diagnostic and Interventional Neuroradiology (A.C., J.K.), Institute of Diagnostic, Interventional and Pediatric Radiology, and Department of Neurology, University Hospital Bern and University of Bern, Inselspital; Department of Neurology and Stroke Center (M.M., S.T., H.G., L.H.B.), University Hospital of Basel; Stroke Center (E.C.), Service de Neurologie, HUG, Geneva; Department of Neurology (T.K., K.N.), Cantonal Hospital Aarau; Stroke Center (A.L.), Department of Neurology, University Hospital of Zürich; and Stroke Center (G.K.), Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland.
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Emmanuel Carrera
From the Stroke Center (C.M., G.D., G.B., C.S., A.C., C.W.C.), Neurocenter of Southern Switzerland, Lugano; Stroke Center and Neurology Service (S.N., P.M., C.W.C.), Department of Clinical Neurosciences, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois); Department of Neurology (M.H., S.J., M.A., U.F.) and Institute of Diagnostic and Interventional Neuroradiology (A.C., J.K.), Institute of Diagnostic, Interventional and Pediatric Radiology, and Department of Neurology, University Hospital Bern and University of Bern, Inselspital; Department of Neurology and Stroke Center (M.M., S.T., H.G., L.H.B.), University Hospital of Basel; Stroke Center (E.C.), Service de Neurologie, HUG, Geneva; Department of Neurology (T.K., K.N.), Cantonal Hospital Aarau; Stroke Center (A.L.), Department of Neurology, University Hospital of Zürich; and Stroke Center (G.K.), Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland.
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Urs Fischer
From the Stroke Center (C.M., G.D., G.B., C.S., A.C., C.W.C.), Neurocenter of Southern Switzerland, Lugano; Stroke Center and Neurology Service (S.N., P.M., C.W.C.), Department of Clinical Neurosciences, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois); Department of Neurology (M.H., S.J., M.A., U.F.) and Institute of Diagnostic and Interventional Neuroradiology (A.C., J.K.), Institute of Diagnostic, Interventional and Pediatric Radiology, and Department of Neurology, University Hospital Bern and University of Bern, Inselspital; Department of Neurology and Stroke Center (M.M., S.T., H.G., L.H.B.), University Hospital of Basel; Stroke Center (E.C.), Service de Neurologie, HUG, Geneva; Department of Neurology (T.K., K.N.), Cantonal Hospital Aarau; Stroke Center (A.L.), Department of Neurology, University Hospital of Zürich; and Stroke Center (G.K.), Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland.
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Timo Kahles
From the Stroke Center (C.M., G.D., G.B., C.S., A.C., C.W.C.), Neurocenter of Southern Switzerland, Lugano; Stroke Center and Neurology Service (S.N., P.M., C.W.C.), Department of Clinical Neurosciences, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois); Department of Neurology (M.H., S.J., M.A., U.F.) and Institute of Diagnostic and Interventional Neuroradiology (A.C., J.K.), Institute of Diagnostic, Interventional and Pediatric Radiology, and Department of Neurology, University Hospital Bern and University of Bern, Inselspital; Department of Neurology and Stroke Center (M.M., S.T., H.G., L.H.B.), University Hospital of Basel; Stroke Center (E.C.), Service de Neurologie, HUG, Geneva; Department of Neurology (T.K., K.N.), Cantonal Hospital Aarau; Stroke Center (A.L.), Department of Neurology, University Hospital of Zürich; and Stroke Center (G.K.), Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland.
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Andreas Luft
From the Stroke Center (C.M., G.D., G.B., C.S., A.C., C.W.C.), Neurocenter of Southern Switzerland, Lugano; Stroke Center and Neurology Service (S.N., P.M., C.W.C.), Department of Clinical Neurosciences, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois); Department of Neurology (M.H., S.J., M.A., U.F.) and Institute of Diagnostic and Interventional Neuroradiology (A.C., J.K.), Institute of Diagnostic, Interventional and Pediatric Radiology, and Department of Neurology, University Hospital Bern and University of Bern, Inselspital; Department of Neurology and Stroke Center (M.M., S.T., H.G., L.H.B.), University Hospital of Basel; Stroke Center (E.C.), Service de Neurologie, HUG, Geneva; Department of Neurology (T.K., K.N.), Cantonal Hospital Aarau; Stroke Center (A.L.), Department of Neurology, University Hospital of Zürich; and Stroke Center (G.K.), Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland.
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Krassen Nedeltchev
From the Stroke Center (C.M., G.D., G.B., C.S., A.C., C.W.C.), Neurocenter of Southern Switzerland, Lugano; Stroke Center and Neurology Service (S.N., P.M., C.W.C.), Department of Clinical Neurosciences, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois); Department of Neurology (M.H., S.J., M.A., U.F.) and Institute of Diagnostic and Interventional Neuroradiology (A.C., J.K.), Institute of Diagnostic, Interventional and Pediatric Radiology, and Department of Neurology, University Hospital Bern and University of Bern, Inselspital; Department of Neurology and Stroke Center (M.M., S.T., H.G., L.H.B.), University Hospital of Basel; Stroke Center (E.C.), Service de Neurologie, HUG, Geneva; Department of Neurology (T.K., K.N.), Cantonal Hospital Aarau; Stroke Center (A.L.), Department of Neurology, University Hospital of Zürich; and Stroke Center (G.K.), Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland.
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Claudio Staedler
From the Stroke Center (C.M., G.D., G.B., C.S., A.C., C.W.C.), Neurocenter of Southern Switzerland, Lugano; Stroke Center and Neurology Service (S.N., P.M., C.W.C.), Department of Clinical Neurosciences, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois); Department of Neurology (M.H., S.J., M.A., U.F.) and Institute of Diagnostic and Interventional Neuroradiology (A.C., J.K.), Institute of Diagnostic, Interventional and Pediatric Radiology, and Department of Neurology, University Hospital Bern and University of Bern, Inselspital; Department of Neurology and Stroke Center (M.M., S.T., H.G., L.H.B.), University Hospital of Basel; Stroke Center (E.C.), Service de Neurologie, HUG, Geneva; Department of Neurology (T.K., K.N.), Cantonal Hospital Aarau; Stroke Center (A.L.), Department of Neurology, University Hospital of Zürich; and Stroke Center (G.K.), Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland.
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Alessandro Cianfoni
From the Stroke Center (C.M., G.D., G.B., C.S., A.C., C.W.C.), Neurocenter of Southern Switzerland, Lugano; Stroke Center and Neurology Service (S.N., P.M., C.W.C.), Department of Clinical Neurosciences, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois); Department of Neurology (M.H., S.J., M.A., U.F.) and Institute of Diagnostic and Interventional Neuroradiology (A.C., J.K.), Institute of Diagnostic, Interventional and Pediatric Radiology, and Department of Neurology, University Hospital Bern and University of Bern, Inselspital; Department of Neurology and Stroke Center (M.M., S.T., H.G., L.H.B.), University Hospital of Basel; Stroke Center (E.C.), Service de Neurologie, HUG, Geneva; Department of Neurology (T.K., K.N.), Cantonal Hospital Aarau; Stroke Center (A.L.), Department of Neurology, University Hospital of Zürich; and Stroke Center (G.K.), Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland.
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Georg Kägi
From the Stroke Center (C.M., G.D., G.B., C.S., A.C., C.W.C.), Neurocenter of Southern Switzerland, Lugano; Stroke Center and Neurology Service (S.N., P.M., C.W.C.), Department of Clinical Neurosciences, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois); Department of Neurology (M.H., S.J., M.A., U.F.) and Institute of Diagnostic and Interventional Neuroradiology (A.C., J.K.), Institute of Diagnostic, Interventional and Pediatric Radiology, and Department of Neurology, University Hospital Bern and University of Bern, Inselspital; Department of Neurology and Stroke Center (M.M., S.T., H.G., L.H.B.), University Hospital of Basel; Stroke Center (E.C.), Service de Neurologie, HUG, Geneva; Department of Neurology (T.K., K.N.), Cantonal Hospital Aarau; Stroke Center (A.L.), Department of Neurology, University Hospital of Zürich; and Stroke Center (G.K.), Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland.
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Leo H. Bonati
From the Stroke Center (C.M., G.D., G.B., C.S., A.C., C.W.C.), Neurocenter of Southern Switzerland, Lugano; Stroke Center and Neurology Service (S.N., P.M., C.W.C.), Department of Clinical Neurosciences, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois); Department of Neurology (M.H., S.J., M.A., U.F.) and Institute of Diagnostic and Interventional Neuroradiology (A.C., J.K.), Institute of Diagnostic, Interventional and Pediatric Radiology, and Department of Neurology, University Hospital Bern and University of Bern, Inselspital; Department of Neurology and Stroke Center (M.M., S.T., H.G., L.H.B.), University Hospital of Basel; Stroke Center (E.C.), Service de Neurologie, HUG, Geneva; Department of Neurology (T.K., K.N.), Cantonal Hospital Aarau; Stroke Center (A.L.), Department of Neurology, University Hospital of Zürich; and Stroke Center (G.K.), Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland.
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Patrik Michel
From the Stroke Center (C.M., G.D., G.B., C.S., A.C., C.W.C.), Neurocenter of Southern Switzerland, Lugano; Stroke Center and Neurology Service (S.N., P.M., C.W.C.), Department of Clinical Neurosciences, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois); Department of Neurology (M.H., S.J., M.A., U.F.) and Institute of Diagnostic and Interventional Neuroradiology (A.C., J.K.), Institute of Diagnostic, Interventional and Pediatric Radiology, and Department of Neurology, University Hospital Bern and University of Bern, Inselspital; Department of Neurology and Stroke Center (M.M., S.T., H.G., L.H.B.), University Hospital of Basel; Stroke Center (E.C.), Service de Neurologie, HUG, Geneva; Department of Neurology (T.K., K.N.), Cantonal Hospital Aarau; Stroke Center (A.L.), Department of Neurology, University Hospital of Zürich; and Stroke Center (G.K.), Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland.
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Carlo W. Cereda
From the Stroke Center (C.M., G.D., G.B., C.S., A.C., C.W.C.), Neurocenter of Southern Switzerland, Lugano; Stroke Center and Neurology Service (S.N., P.M., C.W.C.), Department of Clinical Neurosciences, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois); Department of Neurology (M.H., S.J., M.A., U.F.) and Institute of Diagnostic and Interventional Neuroradiology (A.C., J.K.), Institute of Diagnostic, Interventional and Pediatric Radiology, and Department of Neurology, University Hospital Bern and University of Bern, Inselspital; Department of Neurology and Stroke Center (M.M., S.T., H.G., L.H.B.), University Hospital of Basel; Stroke Center (E.C.), Service de Neurologie, HUG, Geneva; Department of Neurology (T.K., K.N.), Cantonal Hospital Aarau; Stroke Center (A.L.), Department of Neurology, University Hospital of Zürich; and Stroke Center (G.K.), Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland.
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Outcome of endovascular therapy in stroke with large vessel occlusion and mild symptoms
Concetta Manno, Giulio Disanto, Giovanni Bianco, Stefania Nannoni, Mirjam Heldner, Simon Jung, Marcel Arnold, Johannes Kaesmacher, Mandy Müller, Sebastian Thilemann, Henrik Gensicke, Emmanuel Carrera, Urs Fischer, Timo Kahles, Andreas Luft, Krassen Nedeltchev, Claudio Staedler, Alessandro Cianfoni, Georg Kägi, Leo H. Bonati, Patrik Michel, Carlo W. Cereda
Neurology Oct 2019, 93 (17) e1618-e1626; DOI: 10.1212/WNL.0000000000008362

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  • Outcome of endovascular therapy in stroke with large vessel occlusion and mild symptoms - January 28, 2020
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Abstract

Objective To compare outcomes after endovascular therapy (EVT) and IV thrombolysis (IVT) in patients with stroke with emergent large vessel occlusion (LVO) and mild neurologic deficits.

Methods This was a retrospective analysis of patients from the Swiss Stroke Registry with admission NIH Stroke Scale score ≤5 and LVO treated by EVT (± IVT) vs IVT alone. The primary endpoint was favorable functional outcome (modified Rankin Scale [mRS] score 0–1) at 3 months. Secondary outcomes were independence (mRS score 0–2), mRS score (ordinal shift analysis), and survival with high disability (mRS score 4–5). Safety endpoints were mortality and symptomatic hemorrhage.

Results Of 11,356 patients, 312 met the criteria and propensity score method matched 108 in each group. A comparably large proportion of patients with EVT and IVT had favorable outcome (63% vs 65.7% respectively; odds ratio 0.94, 95% confidence interval 0.51–1.72; p = 0.840). Patients with EVT showed a nonsignificant trend toward higher mRS score at 3 months (p = 0.717), while the proportion of surviving patients with high disability was comparably very low in both groups (p = 0.419). Mortality was slightly higher among those with EVT (9.3% vs 2.8%; p = 0.06), and symptomatic intracranial hemorrhage was a rare event in both groups (2.8% vs 0%; p = 0.997).

Conclusions In acute ischemic stroke, EVT and IVT appear similarly effective in achieving favorable outcome at 3 months for patients with LVO and mild neurologic symptoms. EVT might be marginally inferior to IVT regarding outcome across all levels of disability and mortality. Further studies are required to determine whether certain subgroups of patients with LVO and mild symptoms benefit from EVT.

Classification of evidence This study provides Class III evidence that patients with LVO and mild symptoms receiving either EVT or IVT had similar favorable functional outcomes at 3 months.

Glossary

AIS=
acute ischemic stroke;
CA=
carotid artery;
CI=
confidence interval;
EVT=
endovascular therapy;
HERMES=
Heart Failure Molecular Epidemiology for Therapeutic Targets;
IVT=
IV thrombolysis;
LVO=
large vessel occlusion;
mRS=
modified Rankin Scale;
mTICI=
modified Thrombolysis in Cerebral Infarction;
NIHSS=
NIH Stroke Scale;
OR=
odds ratio;
PRISMS=
Potential of rtPA for Ischemic Stroke With Mild Symptoms;
PS=
propensity score;
sICH=
symptomatic intracranial hemorrhage

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Class of Evidence: NPub.org/coe

  • Received December 5, 2018.
  • Accepted in final form May 21, 2019.
  • © 2019 American Academy of Neurology
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