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

Background: 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. Methods: 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. Results: 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). Conclusions: 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.