Safety and Efficacy of Endovascular Thrombectomy for Minor and Major Stroke

Background Endovascular thrombectomy (EVT) is established as the standard treatment for acute ischemic stroke due to large‐vessel occlusion. However, evidence regarding its efficacy in patients with tandem lesions (TLs) and low National Institutes of Health Stroke Scale (NIHSS) scores remains limited. Objective To evaluate the safety and efficacy of EVT in patients with anterior circulation TLs and low NIHSS scores (<5) compared to those with higher scores. Methods We conducted a sub‐analysis of an international multicenter registry including consecutive patients with TLs treated with EVT and acute carotid stenting between January 2015 and December 2020. Patients were divided into minor stroke (NIHSS <5) and major stroke (NIHSS ≥5) groups. Primary outcomes included 90‐day modified Rankin Scale (mRS), functional independence (mRS 0‐2), and symptomatic intracranial hemorrhage. Results Of 595 patients, 27 (4.5%) presented with minor strokes. Patients with minor strokes had longer last‐known‐well‐to‐groin puncture times (799 vs. 350.5 minutes, p<0.001), were less likely to receive intravenous thrombolysis (22.2% vs. 43.7%, p=0.027), and more likely to receive carotid stenting (81.5% vs. 61.1%, p=0.033) compared to those with major strokes. Despite these differences, there were no significant differences in functional outcomes or safety measures between groups. Conclusions EVT appears to be safe and effective for patients with TLs regardless of initial NIHSS score. These findings support consideration of EVT for patients with TLs and low NIHSS scores, though further research with larger sample sizes is needed to confirm these results.