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• W3200248932 abstract "Endovascular therapy (EVT) is the standard of care for patients with acute ischemic stroke because of anterior circulation large vessel occlusion (LVO) causing severe or potentially disabling deficits, typically defined as an NIH Stroke Scale (NIHSS) score of ≥6. Dr. Volny et al. examined the safety and effectiveness of EVT in patients with anterior circulation LVO and an NIHSS score of ≤6, presenting within 12 hours from last known well, using 3 prospective international cohorts. Although patients receiving EVT had a higher risk of neurologic deterioration at 24 hours, these patients had similar excellent clinical outcomes at 90 days when compared with patients receiving medical management alone. In a reader response, Dr. Heldner examines the outcomes of patients with LVO and an NIHSS score of ≤5 in the retrospective single-center Bernese stroke cohort, with 39 patients receiving EVT and 42 receiving medical management. Dr. Heldner reports better 90-day outcomes and less frequent neurologic deterioration in the EVT group, with the important caveat that rates of IV thrombolysis were much lower in the Bernese medical management group than in the study by Dr. Volny et al. Patients with proximal M2 occlusions were also not included in the Bernese analysis. Dr. Heldner calls for randomized controlled trials (RCTs) to find the optimal therapy for this low NIHSS patient population. In response, the authors agree that RCTs are needed and mention ongoing trials on this topic (such as ENDOLOW, [NCT04167527][1], and MOSTE, [NCT03796468][2]). Endovascular therapy (EVT) is the standard of care for patients with acute ischemic stroke because of anterior circulation large vessel occlusion (LVO) causing severe or potentially disabling deficits, typically defined as an NIH Stroke Scale (NIHSS) score of ≥6. Dr. Volny et al. examined the safety and effectiveness of EVT in patients with anterior circulation LVO and an NIHSS score of ≤6, presenting within 12 hours from last known well, using 3 prospective international cohorts. Although patients receiving EVT had a higher risk of neurologic deterioration at 24 hours, these patients had similar excellent clinical outcomes at 90 days when compared with patients receiving medical management alone. In a reader response, Dr. Heldner examines the outcomes of patients with LVO and an NIHSS score of ≤5 in the retrospective single-center Bernese stroke cohort, with 39 patients receiving EVT and 42 receiving medical management. Dr. Heldner reports better 90-day outcomes and less frequent neurologic deterioration in the EVT group, with the important caveat that rates of IV thrombolysis were much lower in the Bernese medical management group than in the study by Dr. Volny et al. Patients with proximal M2 occlusions were also not included in the Bernese analysis. Dr. Heldner calls for randomized controlled trials (RCTs) to find the optimal therapy for this low NIHSS patient population. In response, the authors agree that RCTs are needed and mention ongoing trials on this topic (such as ENDOLOW, [NCT04167527][1], and MOSTE, [NCT03796468][2]). [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04167527&atom=%2Fneurology%2F97%2F11%2F557.2.atom [2]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03796468&atom=%2Fneurology%2F97%2F11%2F557.2.atom" @default.
• W3200248932 created "2021-09-27" @default.
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• W3200248932 date "2021-09-14" @default.
• W3200248932 modified "2023-09-23" @default.
• W3200248932 title "Editors' Note: Thrombectomy vs Medical Management in Low NIHSS Acute Anterior Circulation Stroke" @default.
• W3200248932 doi "https://doi.org/10.1212/wnl.0000000000012549" @default.
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