title: Outcomes in patients with acute ischemic stroke from proximal intracranial vessel occlusion and NIHSS score below 8.
abstract: OBJECTIVE
  Acute ischemic stroke due to proximal intracranial vessel occlusion is associated with poor prognosis and neurologic outcomes. Outcomes specifically in patients with stroke due to these occlusions and lower National Institutes of Health Stroke Scale (NIHSS) scores (0-7 range) have not been described previously.
  
  
  METHODS
  We retrospectively reviewed discharge outcomes (reported in our 'Get With the Guidelines-Stroke' database) in patients with an admission NIHSS score of 0-7 due to proximal intracranial large vessel occlusion (based on CT angiography results) who were excluded from receiving intravenous (IV) thrombolysis with recombinant tissue plasminogen activator and endovascular intra-arterial (IA) stroke interventions.
  
  
  RESULTS
  Among the 204 patients included in our analysis, younger age and lower admission NIHSS score (0-4 range) were strong predictors of good outcome (defined as ability to ambulate independently) at discharge whereas female sex was a predictor of poor outcome. There was no significant difference between cerebrovascular risk factors, specific sites of occlusion, or presenting symptoms and outcomes at discharge. There was great variability in functional outcomes at discharge and discharge disposition (home versus acute or subacute facility or nursing home versus death/hospice) with a trend toward worse outcomes in patients with higher (5-7 range) NIHSS scores on admission.
  
  
  CONCLUSIONS
  Patients with acute stroke due to large vessel occlusion and low admission NIHSS scores (0-7 range) may have poor functional outcomes at discharge. These patients, if not eligible for IV thrombolysis, might benefit from IA revascularization therapies.
authors.affiliation: Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.
authors.forename: Maxim
authors.initials: M
authors.lastname: Mokin
authors.affiliation: Department of Neurology, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurology, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.
authors.forename: Muhammad W
authors.initials: MW
authors.lastname: Masud
authors.affiliation: Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.
authors.forename: Travis M
authors.initials: TM
authors.lastname: Dumont
authors.affiliation: Department of Neurology, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurology, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.
authors.forename: Ghasan
authors.initials: G
authors.lastname: Ahmad
authors.affiliation: Department of Neurology, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurology, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.
authors.forename: Tareq
authors.initials: T
authors.lastname: Kass-Hout
authors.affiliation: Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA Department of Neurology, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Radiology, University at Buffalo, State University of New York, Buffalo, New York, USA Toshiba Stroke and Research Vascular Center, University at Buffalo, State University of New York, Buffalo, New York, USA.
authors.forename: Kenneth V
authors.initials: KV
authors.lastname: Snyder
authors.affiliation: Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA Department of Radiology, University at Buffalo, State University of New York, Buffalo, New York, USA Toshiba Stroke and Research Vascular Center, University at Buffalo, State University of New York, Buffalo, New York, USA Jacobs Institute, Buffalo, New York, USA.
authors.forename: L Nelson
authors.initials: LN
authors.lastname: Hopkins
authors.affiliation: Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA Department of Radiology, University at Buffalo, State University of New York, Buffalo, New York, USA Toshiba Stroke and Research Vascular Center, University at Buffalo, State University of New York, Buffalo, New York, USA.
authors.forename: Adnan H
authors.initials: AH
authors.lastname: Siddiqui
authors.affiliation: Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA Department of Radiology, University at Buffalo, State University of New York, Buffalo, New York, USA Toshiba Stroke and Research Vascular Center, University at Buffalo, State University of New York, Buffalo, New York, USA.
authors.forename: Elad I
authors.initials: EI
authors.lastname: Levy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000150:complications / Q000601:surgery*; D004434:Early Ambulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D012189:Retrospective Studies; D020521:Stroke / Q000601:surgery*; D016896:Treatment Outcome
keywords: Stroke