@article{3105294,
    title = "Medical Management vs Mechanical Thrombectomy for Mild Strokes: An International Multicenter Study and Systematic Review and Meta-analysis",
    author = "Goyal, N. and Tsivgoulis, G. and Malhotra, K. and Ishfaq, M.F. and Pandhi, A. and Frohler, M.T. and Spiotta, A.M. and Anadani, M. and Psychogios, M. and Maus, V. and Siddiqui, A. and Waqas, M. and Schellinger, P.D. and Groen, M. and Krogias, C. and Richter, D. and Saqqur, M. and Garcia-Bermejo, P. and Mokin, M. and Leker, R. and Cohen, J.E. and Katsanos, A.H. and Magoufis, G. and Psychogios, K. and Lioutas, V. and Vannostrand, M. and Sharma, V.K. and Paciaroni, M. and Rentzos, A. and Shoirah, H. and Mocco, J. and Nickele, C. and Inoa, V. and Hoit, D. and Elijovich, L. and Alexandrov, A.V. and Arthur, A.S.",
    journal = "JAMA Neurology",
    year = "2020",
    volume = "77",
    number = "1",
    pages = "16-24",
    publisher = "American Medical Association",
    issn = "2168-6149, 2168-6157",
    doi = "10.1001/jamaneurol.2019.3112",
    keywords = "aging;  Article;  blood vessel occlusion;  brain hemorrhage;  cerebrovascular accident;  drug therapy;  emergency large vessel occlusion;  follow up;  human;  intermethod comparison;  mechanical thrombectomy;  meta analysis;  mortality rate;  patient safety;  priority journal;  Rankin scale;  sex ratio;  systematic review;  therapy effect;  treatment outcome;  adverse event;  aged;  brain hemorrhage;  cerebrovascular accident;  clinical trial;  convalescence;  female;  fibrinolytic therapy;  male;  middle aged;  multicenter study;  procedures;  thrombectomy, Aged;  Cerebral Hemorrhage;  Female;  Humans;  Male;  Middle Aged;  Recovery of Function;  Stroke;  Thrombectomy;  Thrombolytic Therapy",
    abstract = "Importance: The benefit of mechanical thrombectomy (MT) in patients with stroke presenting with mild deficits (National Institutes of Health Stroke Scale [NIHSS] score <6) owing to emergency large-vessel occlusion (ELVO) remains uncertain. Objective: To assess the outcomes of patients with mild-deficits ELVO (mELVO) treated with MT vs best medical management (bMM). Data Sources: We retrospectively pooled patients with mELVO during a 5-year period from 16 centers. A meta-analysis of studies reporting efficacy and safety outcomes with MT or bMM among patients with mELVO was also conducted. Data were analyzed between 2013 and 2017. Study Selection: We identified studies that enrolled patients with stroke (within 24 hours of symptom onset) with mELVO treated with MT or bMM. Main Outcomes and Measures: Efficacy outcomes included 3-month favorable functional outcome and 3-month functional independence that were defined as modified Rankin Scale scores of 0 to 1 and 0 to 2, respectively. Safety outcomes included 3-month mortality and symptomatic and asymptomatic intracranial hemorrhage (ICH). Results: We evaluated a total of 251 patients with mELVO who were treated with MT (n = 138; 65 women; mean age, 65.2 years; median NIHSS score, 4; interquartile range [IQR], 3-5) or bMM (n = 113; 51 women; mean age, 64.8; median NIHSS score, 3; interquartile range [IQR], 2-4). The rate of asymptomatic ICH was lower in bMM (4.6% vs 17.5%; P =.002), while the rate of 3-month FI (after imputation of missing follow-up evaluations) was lower in MT (77.4% vs 88.5%; P =.02). The 2 groups did not differ in any other efficacy or safety outcomes. In multivariable analyses, MT was associated with higher odds of asymptomatic ICH (odds ratio [OR], 11.07; 95% CI, 1.31-93.53; P =.03). In the meta-analysis of 4 studies (843 patients), MT was associated with higher odds of symptomatic ICH in unadjusted analyses (OR, 5.52; 95% CI, 1.91-15.49; P =.002; I2 = 0%). This association did not retain its significance in adjusted analyses including 2 studies (OR, 2.06; 95% CI, 0.49-8.63; P =.32; I2 = 0%). The meta-analysis did not document any other independent associations between treatment groups and safety or efficacy outcomes. Conclusions and Relevance: Our multicenter study coupled with the meta-analysis suggests similar outcomes of MT and bMM in patients with stroke with mELVO, but no conclusions about treatment effect can be made. The clinical equipoise can further be resolved by a randomized clinical trial. © 2019 American Medical Association. All rights reserved."
}