Relevance of National Institutes of Health Stroke Scale subitems for best revascularization therapy in minor stroke patients with large vessel occlusion: An observational multicentric study
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| Titel: | Relevance of National Institutes of Health Stroke Scale subitems for best revascularization therapy in minor stroke patients with large vessel occlusion: An observational multicentric study |
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| Autoren: | Palazzo, Paola, Padlina, Giovanna, Dobrocky, Tomas, Strambo, Davide, Seners, Pierre, Mechtouff, Laura, Turc, Guillaume, Rosso, Charlotte, Almiri, William, Antonenko, Kateryna, Laksiri, Nadia, Sibon, Igor, Detante, Olivier, Mordasini, Pasquale, Michel, Patrik, Heldner, Mirjam |
| Weitere Verfasser: | CarMeN, laboratoire, MINOR STROKE Collaborators, HAL-UPMC, Gestionnaire, Institut de psychiatrie et neurosciences de Paris (IPNP - U1266 Inserm), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Centre Hospitalier Sainte Anne Paris, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut du Cerveau = Paris Brain Institute (ICM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière AP-HP, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Universität Bern = University of Bern = Université de Berne (UNIBE), Hôpital de la Timone CHU - APHM (TIMONE), Centre Hospitalier Universitaire de Bordeaux (CHU Bordeaux), GIN Grenoble Institut des Neurosciences (GIN), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), Centre Hospitalier Universitaire Vaudois = Lausanne University Hospital Lausanne (CHUV), Bern University Hospital Berne (Inselspital), Inselspital Bern, Hôpital Fondation Adolphe de Rothschild = Adolphe de Rothschild Foundation Hospital, Hospices Civils de Lyon (HCL), Groupe hospitalier universitaire Paris psychiatrie & neurosciences Paris (GHU Paris Psychiatrie et Neurosciences), FHU NeuroVasc Site Sainte-Anne, Paris (GHU-PPN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), CHU Pitié-Salpêtrière AP-HP, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Universitaire CHU Grenoble (CHUGA), Brustzentrum Kantonsspital St. Gallen |
| Quelle: | European journal of neurology, vol. 30, no. 12, pp. 3741-3750 |
| Verlagsinformationen: | Wiley, 2023. |
| Publikationsjahr: | 2023 |
| Schlagwörter: | Male, acute ischemic stroke, MESH: Endovascular Procedures, United States, Humans, Female, Aged, Brain Ischemia/surgery, Brain Ischemia/drug therapy, Ischemic Stroke/etiology, Treatment Outcome, Endovascular Procedures/adverse effects, Stroke/surgery, Stroke/drug therapy, Thrombolytic Therapy, Thrombectomy, National Institutes of Health (U.S.), acute stroke management, mild symptoms, [SDV]Life Sciences [q-bio], MESH: Stroke, Brain Ischemia, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, MESH: United States, MESH: Thrombectomy, [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], MESH: Treatment Outcome, Ischemic Stroke, MESH: Aged, MESH: Thrombolytic Therapy, MESH: Humans, Endovascular Procedures, MESH: Brain Ischemia, MESH: Male, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, 3. Good health, [SDV] Life Sciences [q-bio], Stroke, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: National Institutes of Health (U.S.), MESH: Female, MESH: Ischemic Stroke |
| Beschreibung: | Background and purposeThe best management of acute ischemic stroke patients with a minor stroke and large vessel occlusion is still uncertain. Specific clinical and radiological data may help to select patients who would benefit from endovascular therapy (EVT). We aimed to evaluate the relevance of National Institutes of Health Stroke Scale (NIHSS) subitems for predicting the potential benefit of providing EVT after intravenous thrombolysis (IVT; “bridging treatment”) versus IVT alone.MethodsWe extracted demographic, clinical, risk factor, radiological, revascularization and outcome data of consecutive patients with M1 or proximal M2 middle cerebral artery occlusion and admission NIHSS scores of 0–5 points, treated with IVT ± EVT between May 2005 and March 2021, from nine prospectively constructed stroke registries at seven French and two Swiss comprehensive stroke centers. Adjusted interaction analyses were performed between admission NIHSS subitems and revascularization modality for two primary outcomes at 3 months: non‐excellent functional outcome (modified Rankin Scale score 2–6) and difference in NIHSS score between 3 months and admission.ResultsOf the 533 patients included (median age 68.2 years, 46% women, median admission NIHSS score 3), 136 (25.5%) initially received bridging therapy and 397 (74.5%) received IVT alone. Adjusted interaction analysis revealed that only facial palsy on admission was more frequently associated with excellent outcome in patients treated by IVT alone versus bridging therapy (odds ratio 0.47, 95% confidence interval 0.24–0.91; p = 0.013). Regarding NIHSS difference at 3 months, no single NIHSS subitem interacted with type of revascularization.ConclusionsThis retrospective multicenter analysis found that NIHSS subitems at admission had little value in predicting patients who might benefit from bridging therapy as opposed to IVT alone. Further research is needed to identify better markers for selecting EVT responders with minor strokes. |
| Publikationsart: | Article |
| Dateibeschreibung: | application/pdf |
| Sprache: | English |
| ISSN: | 1468-1331 1351-5101 |
| DOI: | 10.1111/ene.16009 |
| Zugangs-URL: | https://pubmed.ncbi.nlm.nih.gov/37517048 https://serval.unil.ch/notice/serval:BIB_7CAD99DC3609 https://serval.unil.ch/resource/serval:BIB_7CAD99DC3609.P001/REF.pdf http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_7CAD99DC36097 |
| Rights: | CC BY NC ND |
| Dokumentencode: | edsair.doi.dedup.....6931db8a0f8962d7445dd91336bedd3e |
| Datenbank: | OpenAIRE |
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Nájsť tento článok vo Web of Science | Abstract: | Background and purposeThe best management of acute ischemic stroke patients with a minor stroke and large vessel occlusion is still uncertain. Specific clinical and radiological data may help to select patients who would benefit from endovascular therapy (EVT). We aimed to evaluate the relevance of National Institutes of Health Stroke Scale (NIHSS) subitems for predicting the potential benefit of providing EVT after intravenous thrombolysis (IVT; “bridging treatment”) versus IVT alone.MethodsWe extracted demographic, clinical, risk factor, radiological, revascularization and outcome data of consecutive patients with M1 or proximal M2 middle cerebral artery occlusion and admission NIHSS scores of 0–5 points, treated with IVT ± EVT between May 2005 and March 2021, from nine prospectively constructed stroke registries at seven French and two Swiss comprehensive stroke centers. Adjusted interaction analyses were performed between admission NIHSS subitems and revascularization modality for two primary outcomes at 3 months: non‐excellent functional outcome (modified Rankin Scale score 2–6) and difference in NIHSS score between 3 months and admission.ResultsOf the 533 patients included (median age 68.2 years, 46% women, median admission NIHSS score 3), 136 (25.5%) initially received bridging therapy and 397 (74.5%) received IVT alone. Adjusted interaction analysis revealed that only facial palsy on admission was more frequently associated with excellent outcome in patients treated by IVT alone versus bridging therapy (odds ratio 0.47, 95% confidence interval 0.24–0.91; p = 0.013). Regarding NIHSS difference at 3 months, no single NIHSS subitem interacted with type of revascularization.ConclusionsThis retrospective multicenter analysis found that NIHSS subitems at admission had little value in predicting patients who might benefit from bridging therapy as opposed to IVT alone. Further research is needed to identify better markers for selecting EVT responders with minor strokes. |
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| ISSN: | 14681331 13515101 |
| DOI: | 10.1111/ene.16009 |