JAMA Sub-Journal: Neurological outcome prediction of simple venous thrombosis therapy in patients with small stroke combined with large vascular thrombosis

A stroke or light stroke is generally defined as a stroke type with a NIHSS score of 6 or 8.
although a minor stroke sounds like a "small" problem, it is not.
A study of 162 patients with mild symptoms of acute stroke showed that 23.5 per cent had poor prognosis and 1.3 per cent died;
the stroke problem is no small matter, small stroke ≠ small ≠ small blood vessels! Why is this a problem? The reason is that a significant proportion of patients with acute ischemic stroke with low NIHSS scores have large vascular cystation (LVO).
the literature reported that 14.2% (54/378) of minor stroke patients (NIHSS score ≤5 points) combined with LVO;
strategy for re-perfusion is not clear for patients with stroke combined with large vascular cystic (LVO) stroke.
in-vascular therapy is not uniform in guidelines or related studies, and there are potential bleeding complications.
what about the recovery of nerve function after venous thrombosis in such patients? How exactly should treatment choices be made for such patients? To this end, the International MINOR-STROKE Collaboration conducted a study, the results of which were published in the latest journal JAMA Neurology.
experts believe that accurate prediction of ischemic venous thrombosis (IVT) in patients with stroke and presumed early nervous system deterioration (ENDI) caused by ischemic disorders may help in the selection of timely thrombosis treatment.
, the study aims to develop and validate an ENDi prediction score that is easy to apply to patients with small stroke combined with LVO venous thrombosis.
the study was a multi-center retrospective queue that included 729 patients who had had a minor stroke and had LVO (base artery, in-neck artery, artery first M1 or M2 segment in the brain).
all patients are treated with venous thrombosis (IVT) at 45 established French stroke centres, including those who end up with a rescue thrombosis due to ENDi.
same time, 347 patients with similar inclusion criteria were collected from nine other clinical centres.
the study, experts defined ENDi as a deterioration of the NIHSS score of ≥4 points within 24 hours of the embolism, with no substantial bleeding or other identified causes as follow-up imaging examinations.
results showed that the median NIHSS score was 3 in all patients, 97 (13.3%) in patients with cervical arteries at the closed site, 207 (28.4%) and 395 (54.2%) in patients with M1 and M2 clement, respectively, and 30 (4.1%) in the base arteries.
88 of these patients had ENDi (12.1%; 95% CI, 9.7-14.4), and even after receiving a remedial thrombosis, the three-month neurosurgery outcome was poor.
multivariable analysis showed that the closer the closure site was to the near end, the longer the thrombosis was independently related to ENDi.
the collaboration group derived a 4-point evaluation method from these variables - 1 is divided into thrombosis length and 3 is divided into closed areas - enDi can be well identified (0.76; 95% CI, 0.70-0.82).
the scoring method is then successfully validated in the validation queue (ENDi rate s 11.0%; 0.78; 95% CI, 0.70-0.86).
, the study found that the ENDi rate explains the current debate over whether to directly combine stroke with IVT treatment in patients with LVO.
and the evaluation method proposed in this paper can effectively predict ENDi risk, thus assisting clinicians in making these decisions.
: Seners P, et al. Prediction of Early Neurological Deterioration in Individuals With Minor Stroke and Large Vessel Occlusion Intended for Intravenous Thrombolysis Alone. JAMA Neurol. 2021 Jan 11. doi: 10.1001/jamaneurol.2020.4557.MedSci Original Source: MedSci Original Copyright Notice: All notes on this website "Source: Met Medical" or "Source: MedSci Original" text, images and audio and video materials, copyrights are owned by Metz Medicine, without authorization, no media, website or individual may reproduce, authorized to reproduce with the words "Source: Mets Medicine".
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