Outcome of patients with occlusions of the internal carotid artery or the main stem of the middle cerebral artery with NIHSS score of less than 5: comparison between thrombolysed and non-thrombolysed patients

Heldner, Mirjam Rachel; Jung, Simon; Zubler, Christoph; Mordasini, Pasquale; Weck, Anja; Mono, Marie-Luise; Ozdoba, Christoph; El-Koussy, Marwan; Mattle, Heinrich P.; Schroth, Gerhard; Gralla, Jan; Arnold, Marcel; Fischer, Urs (2015). Outcome of patients with occlusions of the internal carotid artery or the main stem of the middle cerebral artery with NIHSS score of less than 5: comparison between thrombolysed and non-thrombolysed patients. Journal of neurology, neurosurgery and psychiatry, 86(7), pp. 755-760. BMJ Publishing Group 10.1136/jnnp-2014-308401

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BACKGROUND AND PURPOSE The use of thrombolysis in patients with minor neurological deficits and large vessel occlusion is controversial. METHODS We compared the outcome of patients with low National Institutes of Health Stroke Scale (NIHSS) scores and large vessel occlusions between thrombolysed and non-thrombolysed patients. RESULTS 88 (1.7%) of 5312 consecutive patients with acute (within 24 h) ischaemic stroke had occlusions of the internal carotid or the main stem of the middle cerebral artery and baseline NIHSS scores ≤5.47 (53.4%) were treated without thrombolysis, and 41 (46.6%) received intravenous thrombolysis, endovascular therapy or both. Successful recanalisation on MR or CT angiography at 24 h was more often observed in thrombolysed than in non-thrombolysed patients (78.9% versus 10.5%; p<0.001). Neurological deterioration (increase of NIHSS score ≥1 compared to baseline) was observed in 22.7% of non-thrombolysed versus 10.3% of thrombolysed after 24 h (p=0.002), in 33.3% versus 12.5% at hospital discharge (p=0.015) and in 41.4% versus 15% at 3 months (p<0.001). Symptomatic intracerebral haemorrhage occurred in two (asymptomatic in five) thrombolysed and in none (asymptomatic in three) non-thrombolysed. Thrombolysis was an independent predictor of favourable outcome (p=0.030) but not survival (p=0.606) at 3 months. CONCLUSIONS Non-thrombolysed patients with mild deficits and large vessel occlusion deteriorated significantly more often within 3 months than thrombolysed patients. Symptomatic intracerebral haemorrhages occurred in less than 5% of patients in both groups. These data suggest that thrombolysis is safe and effective in these patients. Therefore, randomised trials in patients with large vessel occlusions and mild or rapidly improving symptoms are needed.

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 and Interventional Neuroradiology

UniBE Contributor:

Heldner, Mirjam Rachel; Jung, Simon; Zubler, Christoph; Mordasini, Pasquale; Weck, Anja; Mono, Marie-Luise; Ozdoba, Christoph; El-Koussy, Marwan; Mattle, Heinrich; Schroth, Gerhard; Gralla, Jan; Arnold, Marcel and Fischer, Urs

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0022-3050

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Valentina Rossetti

Date Deposited:

13 Oct 2014 15:58

Last Modified:

29 Dec 2017 09:47

Publisher DOI:

10.1136/jnnp-2014-308401

PubMed ID:

25266203

BORIS DOI:

10.7892/boris.59080

URI:

https://boris.unibe.ch/id/eprint/59080

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