Clinical effect of successful reperfusion in patients presenting with NIHSS < 8: data from the BEYOND-SWIFT registry

Kaesmacher, Johannes; Chaloulos-Iakovidis, Panagiotis; Panos, Leonidas; Mordasini, Pasquale; Heldner, Mirjam Rachel; Kurmann, Christoph C.; Michel, P.; Hajdu, S. D.; Ribo, M.; Requena, M.; Maegerlein, C.; Friedrich, B.; Costalat, V.; Benali, A.; Pierot, L.; Gawlitza, M.; Schaafsma, J.; Pereira, V. M.; Gralla, Jan and Fischer, Urs (2019). Clinical effect of successful reperfusion in patients presenting with NIHSS < 8: data from the BEYOND-SWIFT registry. Journal of neurology, 266(3), pp. 598-608. Springer-Medizin-Verlag 10.1007/s00415-018-09172-1

[img]
Preview
Text
Kaesmacher2019_Article_ClinicalEffectOfSuccessfulRepe.pdf - Published Version
Available under License Creative Commons: Attribution (CC-BY).

Download (1MB) | Preview

BACKGROUND AND PURPOSE: If patients presenting with large vessel occlusions (LVO) and mild symptoms should be treated with endvoascular treatment (EVT) remains unclear. Aims of this study were (1) assessing the safety and technical efficacy of EVT in patients with NIHSS < 8 as opposed to a comparison group of patients presenting with NIHSS >/= 8 and (2) evaluation of the clinical effect of reperfusion in patients with NIHSS < 8. METHODS: Patients included into the retrospective multicenter BEYOND-SWIFT registry (NCT03496064) were analyzed. Clinical effect of achieving successful reperfusion (defined as modified Thrombolysis in Cerebral Infarction grade 2b/3) in patients presenting with NIHSS < 8 (N = 193) was evaluated using multivariable logistic regression analyses (displayed as adjusted Odds Ratios, aOR and 95 confidence intervals, 95-CI). Primary outcome was excellent functional outcome (modified Rankin Scale, mRS 0-1) at day 90. Safety and efficacy of mechanical thrombectomy in patients with NIHSS < 8 was compared to patients presenting with NIHSS >/= 8 (N = 1423). RESULTS: Among patients with NIHSS < 8 (N = 193, 77/193, 39.9 receiving pre-interventional IV-tPA), successful reperfusion was significantly related to mRS 0-1 (aOR 3.217, 95-CI 1.174-8.816) and reduced the chances of non-hemorrhagic neurological worsening (aOR 0.194, 95-CI 0.050-0.756) after adjusting for prespecified confounders. In interaction analyses, the relative merits of achieving successful reperfusion were mostly comparable between patients presenting with NIHSS < 8 and NIHSS >/= 8 as evidenced by non-significantly different aOR. Interventional safety and efficacy metrics were similar between patients with NIHSS < 8 and NIHSS >/= 8. CONCLUSIONS: Achieving successful reperfusion is beneficial in patients with persisting LVO presenting with NIHSS < 8 and reduces the risk of non-hemorrhagic neurological worsening.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Kaesmacher, Johannes; Chaloulos-Iakovidis, Panagiotis; Panos, Leonidas; Mordasini, Pasquale; Heldner, Mirjam Rachel; Gralla, Jan and Fischer, Urs

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0340-5354

Publisher:

Springer-Medizin-Verlag

Language:

English

Submitter:

Panagiota Milona

Date Deposited:

20 Feb 2019 09:23

Last Modified:

21 Feb 2019 01:33

Publisher DOI:

10.1007/s00415-018-09172-1

PubMed ID:

30617997

Uncontrolled Keywords:

*Endovascular *Low NIHSS *Mechanical thrombectomy *Mild symptoms *Stroke *Thrombolysis

BORIS DOI:

10.7892/boris.124709

URI:

https://boris.unibe.ch/id/eprint/124709

Actions (login required)

Edit item Edit item
Provide Feedback