Clinical Outcome of Patients With Large Vessel Occlusion and Low National Institutes of Health Stroke Scale Scores
Takuya Saito, Ryo Itabashi, Yukako Yazawa, Kazutaka Uchida, Hiroshi Yamagami, Nobuyuki Sakai, Takeshi Morimoto, Shinichi Yoshimura, Ryosuke Doijiri, Yukiko Enomoto, Masayuki Ezura, Norihito Fukawa, Eisuke Furui, Akira Handa, Koichi Haraguchi, Taketo Hatano, Makoto Hayase, Nagayasu Hiyama, Koji Iihara, Norio Ikeda, Keisuke Imai, Hideyuki Ishihara, Yuki Kamiya, Chisaku Kanbayashi, Kazumi Kimura, Kazuo Kitagawa, Yoshihiro Kiura, Junya Kobayashi, Takao Kojima, Ryushi Kondo, Naoya Kuwayama, Yuji Matsumaru, Keigo Matsumoto, Yoshihisa Matsumoto, Kazuo Minematsu, Masafumi Morimoto, Kohei Nii, Kuniaki Ogasawara, Hiroyuki Ohnishi, Hajime Ohta, Takahiro Ohta, Yasushi Okada, Toshiyuki Onda, Manabu Sakaguchi, Shigeyuki Sakamoto, Makoto Sasaki, Junichiro Satomi, Masunari Shibata, Atsushi Shindo, Masataka Takeuchi, Norio Tanahashi, Naoki Toma, Ḱazunori Toyoda, Tomoyuki Tsumoto, Wataro Tsuruta, Naoyuki Uchiyama, Yoshiki Yagita, Taro Yamashita, Daisuke Yamamoto, Ikuya Yamaura, Takaaki Yamazaki, Hiroaki Yasuda
Abstract
Background and Purpose— The treatment and prognosis of acute large vessel occlusion with mild symptoms have not been sufficiently studied. The present study aimed to investigate the clinical or radiological predictors of clinical outcome in patients with stroke with mild symptoms due to acute large vessel occlusion. Methods— Of 2420 patients with acute large vessel occlusion in the RESCUE-Japan Registry 2 (Recovery by Endovascular Salvage for Cerebral Ultra-Acute Embolism-Japan Registry 2), a multicenter prospective registry in Japan, patients with modified Rankin Scale scores of 0 to 2 before onset and initial National Institutes of Health Stroke Scale (NIHSS) scores of 0 to 5 were examined in post hoc analysis. We examined the clinical and radiological characteristics associated with a favorable outcome (modified Rankin Scale score, 0–2 at 90 days) using multivariate analysis, as well as the factors associated with a favorable outcome in patients treated with endovascular therapy. Results— We analyzed 272 patients (median age, 73 years; median NIHSS score on admission, 3). Eighty-six (31.6%) patients were treated with intravenous recombinant tissue-type plasminogen activator, 54 (19.9%) underwent endovascular therapy, and 208 (76.5%) showed a favorable outcome. In multivariate analysis, age <75 years (odds ratio [OR], 2.42 [95% CI, 1.30–4.50]), initial NIHSS score 0 to 3 (OR, 3.08 [95% CI, 1.59–5.98]), intravenous recombinant tissue-type plasminogen activator (OR, 2. 86 [95% CI, 1.32–6.21]), and blood glucose level ≤140 mg/dL (OR, 2.37 [95% CI, 1.22–4.60]) were independently associated with a favorable outcome. However, endovascular therapy was not associated with a favorable outcome (OR, 1.65 [95% CI, 0.71–3.88]). Among 54 patients treated with endovascular therapy, good reperfusion status was more common in the favorable outcome group (88.6% versus 60.0%; P <0.05). Conclusions— Younger age, lower initial NIHSS score, intravenous recombinant tissue-type plasminogen activator, and absence of hyperglycemia were independently associated with a favorable outcome in patients with acute large vessel occlusion with low NIHSS scores. Registration— URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02419794.