Endovascular Treatment Versus Best Medical Therapy in Acute Ischemic Stroke Patients with Mild Symptoms

The benefit of endovascular treatment (EVT) for acute ischemic stroke patients with mild deficits is unknown. We sought to evaluate the natural history of patients with a low National Institute of Health Stroke Score (NIHSS) and an intracranial occlusion. We included patients with a computed tomography angiogram–proven intracranial arterial occlusion who presented within 24 hours of symptom onset with an NIHSS of ≤6. We compared outcomes of patients who were treated with EVT and those who were not by performing propensity score–matched analysis. Primary outcome was modified Rankin score (mRS) at 90 days. A total of 66 patients were included: 38 were men (57.6%) with a median age of 69 (interquartile range [IQR], 57–79.5) years. Median NIHSS was 3 (IQR, 2–5). Median time from symptom onset to presentation was 2.87 hours (IQR, 1.3–5.9). Forty of the total cohort underwent best medical therapy alone (60.6%), whereas 26 underwent EVT (39.4%). Nineteen of the 26 patients who underwent EVT had a good clinical outcome (mRS ≤2) (73.1%), compared with 29 of 40 best medical therapy patients (72.5%) (odds ratio, 0.833 with 95% confidence interval, 0.263–2.631; P = 0.755). Following propensity score adjustment there was a tendency toward lower mRS following EVT (P = 0.051). Despite the higher number of proximal occlusions in the EVT group, overall outcomes were similar, with >70% of patients in each cohort having a good outcome at 90 days.