Low NIHSS Stroke due to Large Vessel Occlusion: What is the Prognosis?

INTRODUCTION: The benefit of mechanical thrombectomy (MT) vs. medical therapy in mild stroke (NIHSS <6) is still being investigated. In this study, we evaluate the prognosis of low NIHSS patients with large vessel occlusion (LVO) who did not undergo MT at admission.
METHODS: This was a retrospective study. Thirty-nine patients with acute ischemic stroke due to large vessel occlusion with mRS 0-2, NIHSS 0-6, were included in the study between 2021-2023. The outcome was evaluated by the modified Rankin Scale score at 90 days.
RESULTS: The mean age of patients was 68.4 (32-97). Twenty-four of them were male, and 15 were female. The median NIHSS score at admission was 3. The most common occlusion site was the M2 segment. Nineteen patients received bridging IVT. Only three patients experienced clinical deterioration and underwent MT during hospitalization. The outcomes between the clinical deterioration and non-deterioration groups did not differ statistically.
DISCUSSION AND CONCLUSION: MT can be performed in low NIHSS stroke patients, especially those with ICA occlusions. To define the exact candidate, the results of ongoing trials such as ENDOLOW and MOSTE are needed.