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More expansive horizons: a review of endovascular therapy for patients with low NIHSS scores
- Source :
- Journal of NeuroInterventional Surgery. 13:146-151
- Publication Year :
- 2020
- Publisher :
- BMJ, 2020.
-
Abstract
- While the landmark 2015 stroke trials demonstrated that endovascular therapy (EVT) was superior to medical management for the treatment of acute ischemic stroke due to large vessel occlusion, the efficacy of EVT for patients presenting with a low NIHSS score remains undetermined. We conducted a review of the EVT low National Institutes of Health Stroke Scale (NIHSS) stroke literature, identifying 24 quantitative and six qualitative publications. Details of study designs and outcome were extracted and critically discussed.All identified qualitative studies were retrospective. There was significant study design heterogeneity, with 18 unique study designs between the 24 identified quantitative manuscripts. Study investigations included low NIHSS EVT feasibility (n=6), EVT versus best medical management (BMM; n=10), EVT versus intravenous therapy (IVT, n=3), and low NIHSS score versus high NIHSS score (n=3). From single-arm EVT feasibility studies, the reported ranges of modified Thrombolysis in Cerebral Infarction and symptomatic intracranial hemorrhage were 78–97% and 0–10%, respectively. The EVT versus BMM literature had heterogeneous results with 40% reporting benefit with EVT and 60% reporting neutral findings. None of the studies comparing EVT with IVT reported a difference between the two revascularization therapies. The four identified meta-analyses had incongruent inclusion criteria and conflicting results. Two randomized trials are currently investigating EVT in patients with a low NIHSS score. Selected meta-analyses do suggest a potential benefit of EVT over BMM; however, current and future randomized clinical trials will better elucidate the efficacy of EVT in this patient population.
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
Revascularization
Endovascular therapy
Brain Ischemia
law.invention
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
law
Internal medicine
medicine
Humans
Thrombolytic Therapy
cardiovascular diseases
030212 general & internal medicine
Stroke
Aged
Retrospective Studies
Thrombectomy
business.industry
Cerebral infarction
Clinical study design
Endovascular Procedures
General Medicine
Thrombolysis
Middle Aged
medicine.disease
Treatment Outcome
Intravenous therapy
Female
Surgery
Neurology (clinical)
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 17598486 and 17598478
- Volume :
- 13
- Database :
- OpenAIRE
- Journal :
- Journal of NeuroInterventional Surgery
- Accession number :
- edsair.doi.dedup.....624be42c08da25a692f51bb62479880e