Elena Zapata-Arriaza, MD, PhD
Lee VH, Thakur G, Nimjee SM, Youssef PP, Lakhani S, Heaton S, Powers CJ. Early neurologic decline in acute ischemic stroke patients receiving thrombolysis with large vessel occlusion and mild deficits. J Neurointerv Surg. 2020.
Large vessel occlusion (LVO) with minor neurological deficit can occur in about 24% of patients with acute ischemic stroke (AIS). The lack of clinical trials addressing this type of patient generates different therapeutic approaches, which impact the natural history of the disease. Lee et al. aim to determine the likelihood of early neurologic deterioration (END) in patients with LVO and low NIHSS treated with rtPA.
The authors performed a retrospective analysis of AIS with low NIHSS (≤7) and LVO (M1, M2, terminal carotid artery -ICAT- and tandem lesions) treated with rtPA from 2014-2019 in a telestroke platform. Most of the included patients were transferred to a tertiary hospital with endovascular treatment availability, and they received CTA on arrival. END was defined as NIHSS worsening of ≥4 within 24 hrs of stroke onset that was not related to symptomatic hemorrhage.