Medical and Endovascular Treatment for Acute Large Vessel Occlusion with Mild Stroke: A Real-World Nationwide Registry

EVT is a standard treatment for LVO in patients with an NIHSS score ≥6, but its role in mild stroke (NIHSS <6) remains uncertain. This study aims to explore the association between EVT and clinical outcomes in mild stroke.

Methods

This non-randomized cohort study prospectively enrolled consecutive mild stroke patients at 35 comprehensive stroke centers across 15 Chinese provinces from January 2020 to December 2023. Patients were categorized into pEVT or BMM groups, including those who received rEVT after deterioration. The primary outcome was an excellent outcome (mRS score of 0-1) at 90 days. Secondary outcomes included a good outcome (mRS score of 0-2) and mRS shift. Safety endpoints were mortality and sICH. Outcomes were compared between groups using multivariable logistic regression and IPTW.

Results

Finally, 307 patients were included. 110 received pEVT, and 190 received BMM. In the IPTW model, the pEVT group had higher rates of excellent (aOR=3.6, 95%CI=2.5-5.2) and good (aOR=4.0, 95%CI=2.5-5.6) outcomes, lower mortality (aOR=0.1, 95%CI=0.01-0.4), and a better 90-day mRS shift (aOR=0.2, 95%CI=0.1-0.3,), with similar sICH rates. Among the BMM group, 80 patients (42.1%) experienced early neurological deterioration (END), with 55 receiving rEVT. In the multivariable model, the pEVT group had higher rates of excellent (aOR=7.2, 95%CI=1.4-37.9) and good (aOR=4.1, 95%CI=1.2-14.8) outcomes and a better mRS shift (aOR=2.0, 95%CI=0.9-4.8).

Conclusions

Primary EVT significantly increases the likelihood of achieving an excellent outcome in mild stroke. Over 40% of mild stroke patients treated with BMM experienced END, and rEVT effectively improved the prognosis.

Key Points