Effectiveness and Safety of Endovascular Treatment in Large Vessel Occlusion Stroke with an NIHSS Score of ≤5 Exhibiting Predominant Cortical Signs
<b>Background</b>: Our study aimed to evaluate the impact of EVT on stroke outcomes in patients with LVO with a National Institute of Health Stroke Scale (NIHSS) score of ≤5, exhibiting primarily cortical signs. <b>Methods</b>: We conducted a multicenter registry-based analys...
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2025-07-01
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| author | Chulho Kim Seung Joon Oh Jae Jun Lee Jong-Hee Sohn Joo Hye Sung Yerim Kim Minwoo Lee Mi Sun Oh Kyung-Ho Yu Hee Jung Mo Sang-Hwa Lee |
| author_facet | Chulho Kim Seung Joon Oh Jae Jun Lee Jong-Hee Sohn Joo Hye Sung Yerim Kim Minwoo Lee Mi Sun Oh Kyung-Ho Yu Hee Jung Mo Sang-Hwa Lee |
| author_sort | Chulho Kim |
| collection | DOAJ |
| description | <b>Background</b>: Our study aimed to evaluate the impact of EVT on stroke outcomes in patients with LVO with a National Institute of Health Stroke Scale (NIHSS) score of ≤5, exhibiting primarily cortical signs. <b>Methods</b>: We conducted a multicenter registry-based analysis of patients with acute ischemic stroke with LVO who arrived within 12 h of onset. Among these, patients with low NIHSS scores and prominent cortical signs (Items 2, 3, 9, or 11) were included. Patients were divided into two groups: those who underwent EVT and those treated with the best medical therapy (BMT), which included intravenous thrombolysis where appropriate. The primary outcome measure was a modified Rankin scale (mRS) score of 0–1 at 3 months and symptomatic hemorrhagic transformation (SHT). We performed logistic regression analysis to evaluate the impact of EVT on the outcomes. <b>Results</b>: Of the 970 patients with LVO, 291 met the inclusion criteria, with 95 and 196 undergoing EVT and BMT, respectively. The EVT group demonstrated a significantly higher rate of 3-month mRS score of 0–1 (65.3% vs. 39.3%, <i>p</i> < 0.001) and a lower incidence of SHT than the BMT group (3.2% vs. 12.8%, <i>p</i> = 0.01). Multivariate analysis confirmed that EVT was associated with improved functional recovery (mRS score, 0–1; odds ratio [OR], 3.61; 95% confidence interval [CI], 1.82–7.06; <i>p</i> < 0.001) and reduced risk of SHT (OR, 0.19; 95% CI, 0.05–0.74; <i>p</i> = 0.02). Notably, patients with specific cortical signs, such as aphasia and spatial neglect, exhibited better outcomes with EVT. <b>Conclusions</b>: EVT may significantly improve the functional outcomes in patients with mild LVO stroke who present with cortical signs, despite low NIHSS scores. These findings suggest that cortical signs should be a key factor in EVT decision-making for mild stroke cases, thereby advocating for a more individualized approach in acute stroke management. |
| format | Article |
| id | doaj-art-e41c2a68265e4efea2dea0dea5ca9276 |
| institution | Kabale University |
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| language | English |
| publishDate | 2025-07-01 |
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| spelling | doaj-art-e41c2a68265e4efea2dea0dea5ca92762025-08-20T03:36:34ZengMDPI AGBiomedicines2227-90592025-07-01137170010.3390/biomedicines13071700Effectiveness and Safety of Endovascular Treatment in Large Vessel Occlusion Stroke with an NIHSS Score of ≤5 Exhibiting Predominant Cortical SignsChulho Kim0Seung Joon Oh1Jae Jun Lee2Jong-Hee Sohn3Joo Hye Sung4Yerim Kim5Minwoo Lee6Mi Sun Oh7Kyung-Ho Yu8Hee Jung Mo9Sang-Hwa Lee10Department of Neurology, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon 24253, Republic of KoreaInstitute of New Frontier Research Team, Hallym University, Chuncheon 24253, Republic of KoreaInstitute of New Frontier Research Team, Hallym University, Chuncheon 24253, Republic of KoreaDepartment of Neurology, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon 24253, Republic of KoreaDepartment of Neurology, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon 24253, Republic of KoreaDepartment of Neurology, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul 05355, Republic of KoreaDepartment of Neurology, Hallym Sacred Heart Hospital, College of Medicine, Hallym University, Anyang 14068, Republic of KoreaDepartment of Neurology, Hallym Sacred Heart Hospital, College of Medicine, Hallym University, Anyang 14068, Republic of KoreaDepartment of Neurology, Hallym Sacred Heart Hospital, College of Medicine, Hallym University, Anyang 14068, Republic of KoreaDepartment of Neurology, Inha University Hospital, Incheon 22332, Republic of KoreaDepartment of Neurology, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon 24253, Republic of Korea<b>Background</b>: Our study aimed to evaluate the impact of EVT on stroke outcomes in patients with LVO with a National Institute of Health Stroke Scale (NIHSS) score of ≤5, exhibiting primarily cortical signs. <b>Methods</b>: We conducted a multicenter registry-based analysis of patients with acute ischemic stroke with LVO who arrived within 12 h of onset. Among these, patients with low NIHSS scores and prominent cortical signs (Items 2, 3, 9, or 11) were included. Patients were divided into two groups: those who underwent EVT and those treated with the best medical therapy (BMT), which included intravenous thrombolysis where appropriate. The primary outcome measure was a modified Rankin scale (mRS) score of 0–1 at 3 months and symptomatic hemorrhagic transformation (SHT). We performed logistic regression analysis to evaluate the impact of EVT on the outcomes. <b>Results</b>: Of the 970 patients with LVO, 291 met the inclusion criteria, with 95 and 196 undergoing EVT and BMT, respectively. The EVT group demonstrated a significantly higher rate of 3-month mRS score of 0–1 (65.3% vs. 39.3%, <i>p</i> < 0.001) and a lower incidence of SHT than the BMT group (3.2% vs. 12.8%, <i>p</i> = 0.01). Multivariate analysis confirmed that EVT was associated with improved functional recovery (mRS score, 0–1; odds ratio [OR], 3.61; 95% confidence interval [CI], 1.82–7.06; <i>p</i> < 0.001) and reduced risk of SHT (OR, 0.19; 95% CI, 0.05–0.74; <i>p</i> = 0.02). Notably, patients with specific cortical signs, such as aphasia and spatial neglect, exhibited better outcomes with EVT. <b>Conclusions</b>: EVT may significantly improve the functional outcomes in patients with mild LVO stroke who present with cortical signs, despite low NIHSS scores. These findings suggest that cortical signs should be a key factor in EVT decision-making for mild stroke cases, thereby advocating for a more individualized approach in acute stroke management.https://www.mdpi.com/2227-9059/13/7/1700large vessel occlusion strokeendovascular treatmentcortical signlow National Institute of Health Stroke Scale scorethree-month modified Rankin scalebleeding |
| spellingShingle | Chulho Kim Seung Joon Oh Jae Jun Lee Jong-Hee Sohn Joo Hye Sung Yerim Kim Minwoo Lee Mi Sun Oh Kyung-Ho Yu Hee Jung Mo Sang-Hwa Lee Effectiveness and Safety of Endovascular Treatment in Large Vessel Occlusion Stroke with an NIHSS Score of ≤5 Exhibiting Predominant Cortical Signs Biomedicines large vessel occlusion stroke endovascular treatment cortical sign low National Institute of Health Stroke Scale score three-month modified Rankin scale bleeding |
| title | Effectiveness and Safety of Endovascular Treatment in Large Vessel Occlusion Stroke with an NIHSS Score of ≤5 Exhibiting Predominant Cortical Signs |
| title_full | Effectiveness and Safety of Endovascular Treatment in Large Vessel Occlusion Stroke with an NIHSS Score of ≤5 Exhibiting Predominant Cortical Signs |
| title_fullStr | Effectiveness and Safety of Endovascular Treatment in Large Vessel Occlusion Stroke with an NIHSS Score of ≤5 Exhibiting Predominant Cortical Signs |
| title_full_unstemmed | Effectiveness and Safety of Endovascular Treatment in Large Vessel Occlusion Stroke with an NIHSS Score of ≤5 Exhibiting Predominant Cortical Signs |
| title_short | Effectiveness and Safety of Endovascular Treatment in Large Vessel Occlusion Stroke with an NIHSS Score of ≤5 Exhibiting Predominant Cortical Signs |
| title_sort | effectiveness and safety of endovascular treatment in large vessel occlusion stroke with an nihss score of ≤5 exhibiting predominant cortical signs |
| topic | large vessel occlusion stroke endovascular treatment cortical sign low National Institute of Health Stroke Scale score three-month modified Rankin scale bleeding |
| url | https://www.mdpi.com/2227-9059/13/7/1700 |
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