title: Outcome of patients with occlusions of the internal carotid artery or the main stem of the middle cerebral artery with NIHSS score of less than 5: comparison between thrombolysed and non-thrombolysed patients.
abstract: OBJECTIVE
  The use of thrombolysis in patients with minor neurological deficits and large vessel occlusion is controversial.
  
  
  METHODS
  We compared the outcome of patients with low National Institutes of Health Stroke Scale (NIHSS) scores and large vessel occlusions between thrombolysed and non-thrombolysed patients.
  
  
  RESULTS
  88 (1.7%) of 5312 consecutive patients with acute (within 24 h) ischaemic stroke had occlusions of the internal carotid or the main stem of the middle cerebral artery and baseline NIHSS scores ≤5.47 (53.4%) were treated without thrombolysis, and 41 (46.6%) received intravenous thrombolysis, endovascular therapy or both. Successful recanalisation on MR or CT angiography at 24 h was more often observed in thrombolysed than in non-thrombolysed patients (78.9% versus 10.5%; p<0.001). Neurological deterioration (increase of NIHSS score ≥1 compared to baseline) was observed in 22.7% of non-thrombolysed versus 10.3% of thrombolysed after 24 h (p=0.002), in 33.3% versus 12.5% at hospital discharge (p=0.015) and in 41.4% versus 15% at 3 months (p<0.001). Symptomatic intracerebral haemorrhage occurred in two (asymptomatic in five) thrombolysed and in none (asymptomatic in three) non-thrombolysed. Thrombolysis was an independent predictor of favourable outcome (p=0.030) but not survival (p=0.606) at 3 months.
  
  
  CONCLUSIONS
  Non-thrombolysed patients with mild deficits and large vessel occlusion deteriorated significantly more often within 3 months than thrombolysed patients. Symptomatic intracerebral haemorrhages occurred in less than 5% of patients in both groups. These data suggest that thrombolysis is safe and effective in these patients. Therefore, randomised trials in patients with large vessel occlusions and mild or rapidly improving symptoms are needed.
authors.affiliation: Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Mirjam R
authors.initials: MR
authors.lastname: Heldner
authors.affiliation: Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Simon
authors.initials: S
authors.lastname: Jung
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Zubler
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Mordasini
authors.affiliation: Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Anja
authors.initials: A
authors.lastname: Weck
authors.affiliation: Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Marie-Luise
authors.initials: ML
authors.lastname: Mono
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Ozdoba
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Marwan
authors.initials: M
authors.lastname: El-Koussy
authors.affiliation: Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Heinrich P
authors.initials: HP
authors.lastname: Mattle
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schroth
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Gralla
authors.affiliation: Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Marcel
authors.initials: M
authors.lastname: Arnold
authors.affiliation: Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Urs
authors.initials: U
authors.lastname: Fischer
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy; D002341:Carotid Artery Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002533:Cerebral Angiography; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D020767:Intracranial Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D018810:Magnetic Resonance Angiography; D008297:Male; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D012720:Severity of Illness Index; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
keywords: CEREBROVASCULAR DISEASE; SCALES; STROKE