Effectiveness and Safety of Mechanical Thrombectomy in Mild Stroke due to Large-Vessel Occlusion: Insights from the ASSIST Registry

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Mild acute ischemic stroke due to large-vessel occlusion (n=1360). Intervention: Mechanical thrombectomy vs. Moderate-severe stroke (NIHSS>5). Primary outcome: Excellent functional outcomes (mRS 0-1) at 90 days.

Q: What does this research mean for the field?

Mechanical thrombectomy in patients with mild stroke due to large-vessel occlusion is effective and safe, with 77.1% achieving excellent 90-day functional outcomes, though an increased number of passes predicts early neurological deterioration. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Sophia Hohenstatt; Dominik F. Vollherbst; Salvador Miralbés; Bharath Naravetla; Alejandro M Spiotta; Christian Loehr; Mario Martínez‐Galdámez; Ryan McTaggart; Luc Defreyne; Pedro Vega; Osama O. Zaidat; Sergio Lucio Vinci; David S. Liebeskind; Rishi Gupta; Markus A Möhlenbruch; Agostino Tessitore

doi:10.3174/ajnr.a8613

December 3, 2024American Journal of NeuroradiologyOpen Access

Effectiveness and Safety of Mechanical Thrombectomy in Mild Stroke due to Large-Vessel Occlusion: Insights from the ASSIST Registry

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Key result

Mechanical thrombectomy in mild stroke yields ~77% excellent 90-day outcomes, but extra passes increase neurological deterioration.

n=1,360

Why the study?

Is mechanical thrombectomy effective and safe in patients with mild stroke (NIHSS≤5) due to large-vessel occlusion?

Key Points

To evaluate the safety and clinical effectiveness of mechanical thrombectomy in patients presenting with mild acute ischemic stroke due to large-vessel occlusion, and to examine whether procedural techniques influence patient outcomes.
Analyzed multicenter observational data from the ASSIST Registry comprising 1,360 anterior circulation large-vessel occlusion stroke patients.
Stratified patients by baseline stroke severity into mild stroke (NIHSS ≤ 5, n = 122) and moderate-to-severe stroke (NIHSS > 5, n = 1,238) cohorts.
Compared procedural success, safety endpoints, and 90-day modified Rankin Scale (mRS) outcomes between cohorts and across thrombectomy techniques within the mild subgroup.
Mild stroke patients achieved an 85.7% functional independence rate (mRS 0–2) and a 77.1% excellent functional outcome rate (mRS 0–1) at 90 days, with comparable procedural success across severity groups.
Independent predictors of early neurological deterioration in mild stroke included total device passes (OR 1.49, 95% CI 1.01–2.19, P = .04) and procedure duration (OR 1.02, 95% CI 1.01–1.04, P = .01).
Patients with early neurological deterioration experienced significantly worse 90-day functional outcomes (mRS 3–6) compared to those without deterioration (89% vs. 6%, P < .001).

Study Design

Type

Cohort (n=1,360)

Structured PICO

Is mechanical thrombectomy effective and safe in patients with mild stroke (NIHSS≤5) due to large-vessel occlusion?

P

Population

1,360 patients with large vessel occlusion of the anterior circulation, including 122 with mild stroke (NIHSS≤5), evaluated for mechanical thrombectomy outcomes at 90 days.

E

Exposure

Mechanical thrombectomy (MT)

C

Comparator

Moderate-severe stroke (NIHSS>5) group, and different MT techniques within the mild stroke subgroup

O

Outcome

Functional outcomes (mRS) at 90 days, procedural success, and safety endpointshard clinical

Implication

Mechanical thrombectomy is effective and safe in mild stroke patients with large vessel occlusion, though increased passes and procedure time predict early neurological deterioration.

Discussion

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Cite This Study

Hohenstatt et al. (2024) conducted a cohort in Mild acute ischemic stroke due to large-vessel occlusion (n=1,360). Mechanical thrombectomy vs. Moderate-severe stroke (NIHSS>5) was evaluated on Excellent functional outcomes (mRS 0-1) at 90 days. Mechanical thrombectomy in mild stroke yielded 77.1% excellent functional outcomes at 90 days, though total passes predicted early neurological deterioration (OR 1.49; 95% CI 1.01-2.19; P=0.04).

synapsesocial.com/papers/6a80e6a771edfdad573c67e4 https://doi.org/10.3174/ajnr.a8613

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Effectiveness and Safety of Mechanical Thrombectomy in Mild Stroke due to Large-Vessel Occlusion: Insights from the ASSIST Registry

Key Points

Study Design

Structured PICO

Implication

Discussion

Cite This Study

Effectiveness and Safety of Mechanical Thrombectomy in Mild Stroke due to Large-Vessel Occlusion: Insights from the ASSIST Registry

Key Points

Study Design

Structured PICO

Implication

Discussion

Cite This Study

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