Analysis of mechanical thrombectomy for acute ischemic strokes with low NIHSS scores and large vessel occlusion

doi:10.11817/j.issn.1673-9248.2023.02.005

Abstract

Abstract:

Objective

To analyze the therapeutic effect of mechanical thrombectomy in patients with acute ischemic strokes with low National Institute of Health stroke scale (NIHSS) scores and large vessel occlusions.

Methods

The clinical data of acute ischemic stroke patients with mechanical thrombectomy admitted to the Neurointerventional Department of You'anmen Hospital from January 2020 to June 2022 were collected. Among them, 25 patients presented with low NIHSS scores and large vessel occlusions. The clinical characteristics of these patients were retrospectively analyzed and summarized. Wilcoxon rank-sum test was used to compare the difference between baseline NIHSS scores and postoperative NIHSS scores at 24 hours and 90 days after the operation.

Results

Among the 25 patients, 19 were male (76.0%), aged (61±13) years. Hypertension was a common comorbidity (56.0%, 14/25). Patients with Alberta stroke program early CT score 10 accounted for 56.0% (14/25). The main etiological type was large-artery atherosclerosis (84.0%, 21/25). 22 patients (88.0%, 22/25) were successfully recanalized and 2 patients (8.0%, 2/25) had asymptomatic intracranial hemorrhage. The NIHSS score at 90 days was lower than the baseline NIHSS score [1 (0, 2) score vs 4 (3, 4) score], with a statistically significant difference (Z=-2.335, P=0.020). The good prognosis rate was 92.0% (23/25) at 90 days follow-up.

Conclusion

Mechanical thrombectomy is feasible as a treatment for patients with low NIHSS scores and large vessel occlusions, and has high safety and vessel recanalization rate.

Key words: Stroke, National Institute of Health stroke scale, Large vessel occlusion, Mechanical thrombectomy

Yang Cao, Kai Zhang, Shiyong Zhang. Analysis of mechanical thrombectomy for acute ischemic strokes with low NIHSS scores and large vessel occlusion[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2023, 17(02): 107-111.

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URL: https://zhnxgbzz.cma-cmc.com.cn/EN/10.11817/j.issn.1673-9248.2023.02.005

https://zhnxgbzz.cma-cmc.com.cn/EN/Y2023/V17/I02/107

Figures/Tables 1

项目	数据	项目	数据
年龄（岁， $x ¯$ ±s）	61±13	受累动脉系统[例（%）]
男性[例（%）]	19（76.0）	左颈内动脉	5（20.0）
高血压[例（%）]	14（56.0）	右颈内动脉	12（48.0）
高脂血症[例（%）]	9（36.0）	椎基底动脉	8（32.0）
糖尿病[例（%）]	10（40.0）	桥接治疗[例（%）]	5（20.0）
既往脑梗死[例（%）]	6（24.0）	手术时间[min，M（Q_R）]	45.0（33.0，55.0）
心房纤颤[例（%）]	2（8.0）	取栓次数（次， $x ¯$ ±s）	1.4±0.6
吸烟[例（%）]	11（44.0）	DPT[min，M（Q_R）]	55.0（30.0，154.0）
TOAST病因分型[例（%）]		PRT（min， $x ¯$ ±s）	43.9±16.8
大动脉粥样硬化型	21（84.0）	手术方式[例（%）]
心源性栓塞	2（8.0）	支架取栓	16（64.0）
小动脉闭塞	0（0）	抽吸取栓	6（24.0）
其他明确病因	1（4.0）	支架+抽吸取栓	3（12.0）
不明原因	1（4.0）	术后出血[例（%）]	2（8.0）
基线NIHS评分[例（%）]		侧支状态[例（%）]
0分	0（0）	代偿良好	22（88.0）
1分	2（8.0）	代偿不足	3（12.0）
2分	4（16.0）	术后mTICI分级[例（%）]
3分	6（24.0）	≥2b级	22（88.0）
4分	8（32.0）	＜2b级	3（12.0）
5分	5（20.0）	90 d mRS评分[例（%）]
基线NIHSS[分，M（Q_R）]	4（3，4）	0分	11（44.0）
24 h NIHSS[分，M（Q_R）]	3（2，4）	1分	8（32.0）
90 d NIHSS[分，M（Q_R）]	1（0，2）	2分	4（16.0）
术前CT（%）	25（100.0）	3分	1（4.0）
ASPECT评分[例（%）]		4分	1（4.0）
7分	2（8.0）	5分	0（0）
8分	4（16.0）	6分	0（0）
9分	5（22.0）
10分	14（56.0）

项目	数据	项目	数据
年龄（岁， $x ¯$ ±s）	61±13	受累动脉系统[例（%）]
男性[例（%）]	19（76.0）	左颈内动脉	5（20.0）
高血压[例（%）]	14（56.0）	右颈内动脉	12（48.0）
高脂血症[例（%）]	9（36.0）	椎基底动脉	8（32.0）
糖尿病[例（%）]	10（40.0）	桥接治疗[例（%）]	5（20.0）
既往脑梗死[例（%）]	6（24.0）	手术时间[min，M（Q_R）]	45.0（33.0，55.0）
心房纤颤[例（%）]	2（8.0）	取栓次数（次， $x ¯$ ±s）	1.4±0.6
吸烟[例（%）]	11（44.0）	DPT[min，M（Q_R）]	55.0（30.0，154.0）
TOAST病因分型[例（%）]		PRT（min， $x ¯$ ±s）	43.9±16.8
大动脉粥样硬化型	21（84.0）	手术方式[例（%）]
心源性栓塞	2（8.0）	支架取栓	16（64.0）
小动脉闭塞	0（0）	抽吸取栓	6（24.0）
其他明确病因	1（4.0）	支架+抽吸取栓	3（12.0）
不明原因	1（4.0）	术后出血[例（%）]	2（8.0）
基线NIHS评分[例（%）]		侧支状态[例（%）]
0分	0（0）	代偿良好	22（88.0）
1分	2（8.0）	代偿不足	3（12.0）
2分	4（16.0）	术后mTICI分级[例（%）]
3分	6（24.0）	≥2b级	22（88.0）
4分	8（32.0）	＜2b级	3（12.0）
5分	5（20.0）	90 d mRS评分[例（%）]
基线NIHSS[分，M（Q_R）]	4（3，4）	0分	11（44.0）
24 h NIHSS[分，M（Q_R）]	3（2，4）	1分	8（32.0）
90 d NIHSS[分，M（Q_R）]	1（0，2）	2分	4（16.0）
术前CT（%）	25（100.0）	3分	1（4.0）
ASPECT评分[例（%）]		4分	1（4.0）
7分	2（8.0）	5分	0（0）
8分	4（16.0）	6分	0（0）
9分	5（22.0）
10分	14（56.0）

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