Clinical Outcome of Patients With Large Vessel Occlusion and Low National Institutes of Health Stroke Scale Scores
Authors: Saito Takuya , Itabashi Ryo , Yazawa Yukako , Uchida Kazutaka , Yamagami Hiroshi , Sakai Nobuyuki , Morimoto Takeshi , Yoshimura Shinichi , Doijiri Ryosuke , Enomoto Yukiko , Ezura Masayuki , Fukawa Norihito , Furui Eisuke , Handa Akira , Haraguchi Koichi , Hatano Taketo , Hayase Makoto , Hiyama Nagayasu , Iihara Koji , Ikeda Norio , Imai Keisuke , Ishihara Hideyuki , Kamiya Yuki , Kanbayashi Chisaku , Kimura Kazumi , Kitagawa Kazuo , Kiura Yoshihiro , Kobayashi Junya , Kojima Takao , Kondo Ryushi , Kuwayama Naoya , Matsumaru Yuji , Matsumoto Keigo , Matsumoto Yoshihisa , Minematsu Kazuo , Morimoto Masafumi , Nii Kohei , Ogasawara Kuniaki , Ohnishi Hiroyuki , Ohta Hajime , Ohta Takahiro , Okada Yasushi , Onda Toshiyuki , Sakaguchi Manabu , Sakamoto Shigeyuki , Sasaki Makoto , Satomi Junichiro , Shibata Masunari , Shindo Atsushi , Takeuchi Masataka , Tanahashi Norio , Toma Naoki , Toyoda Kazunori , Tsumoto Tomoyuki , Tsuruta Wataro , Uchiyama Naoyuki , Yagita Yoshiki , Yamashita Taro , Yamamoto Daisuke , Yamaura Ikuya , Yamazaki Takaaki , Yasuda Hiroaki 
Published: April 2020

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.