Patterns and Outcomes of Endovascular Therapy in Mild Stroke: A Florida-Puerto Rico Collaboration

• Type of Material: Article
• Authors: Negar Asdaghi, University of Miami; Dileep R. Yavagal, University of Miami; Kefeng Wang, University of Miami; Nils Mueller-Kronast, Delray Medical Center; Nirav Bhatt, Emory University; Hannah E. Gardener, University of Miami; Carolina M. Gutierrez, University of Miami; Erika Marulanda-Londono, University of Miami; Sebastian Koch, University of Miami; Chuanhui Dong, University of Miami; Sophia A. Oluwole, University of Miami; Ricardo Hanel, Baptist Neurological Institute; Brijesh Mehta, Memorial Regional Hospital; Mary Robichaux, VP Parotis Healthcare LLC; Ulises Nobo, HIMA San Pablo Hospital; Juan C. Zevallos, Florida International University; Tatjana Rundek, University of Miami; Ralph L. Sacco, University of Miami; Jose G. Romano, University of Miami
• Language: English
• Date: 2019-08-01
• Publisher: Lippincott Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 American Heart Association, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1161/STROKEAHA.118.023893
• Title of Journal or Parent Work: Stroke
• Volume: 50
• Issue: 8
• Start Page: 2101
• End Page: 2107
• Grant/Funding Information: Study Funded by the National Institute of Health (NIH)/National Institute of Neurological Disorders (NINDS) through the Stroke Prevention and Intervention Research Program (SPIRP) cooperative grant (Grant Number: U54NS081763) and the Florida Department of Health.
• Keywords: Life Sciences & Biomedicine; Association; embolectomy; stroke; Peripheral Vascular Disease; Florida; Clinical Neurology; Acute ischemic stroke; Guidelines; Science & Technology; Cardiovascular System & Cardiology; hospitals; Mechanical thrombectomy; Minimal symptoms; Middle cerebral artery; Vessel occlusion strokes; Neurosciences & Neurology; Management
• Research Categories: Health Sciences, Medicine and Surgery; Biology, Neuroscience; Health Sciences, Rehabilitation and Therapy

Abstract

Background and purpose: We aimed to evaluate the current practice patterns, safety and outcomes of patients who receive endovascular therapy (EVT) having mild neurological symptoms. Methods: From Jan 2010 to Jan 2018, 127,794 ischemic stroke patients were enrolled in the Florida-Puerto Rico Stroke Registry. Patients presenting within 24 hours of symptoms who received EVT were classified into mild (NIHSS ≤ 5) or moderate/severe (NIHSS > 5) categories. Differences in clinical characteristics and outcomes were evaluated using multivariable logistic regression. Results: Among 4,110 EVT patients (median age 73 (IQR=20), 50% women), 446 (11%) had NIHSS≤5. Compared to NIHSS>5, those with NIHSS≤5 arrived later to the hospital (median 138 vs. 101 min), were less likely to receive intravenous alteplase (30% vs. 43%), had a longer door to puncture time (median 167 vs. 115 min) and more likely treated in South Florida (64% vs. 53%). In multivariable analysis younger age, private insurance (vs. Medicare), history of hypertension, prior independent ambulation and hospital size were independent characteristics associated with NIHSS ≤5. Amongst EVT patients with NIHSS≤5, 76% were discharged home/rehabilitation and 64% were able to ambulate independently at discharge as compared to 53% and 32% of patients with NIHSS>5. Symptomatic ICH occurred in 4% of mild stroke EVT patients and 6.4% in those with NIHSS>5. Conclusion: Despite lack of evidence-based recommendations, 11% of patients receiving EVT in clinical practice have mild neurological presentations. Individual, hospital and geographical disparities are observed amongst endovascularly treated patients based on the severity of clinical symptoms. Our data suggest safety and overall favorable outcomes for EVT patients with mild stroke.