Outcomes in patients with acute ischemic stroke from proximal intracranial vessel occlusion and NIHSS score below 8

Maxim Mokin, Muhammad W. Masud, Travis M Dumont, Ghasan Ahmad, Tareq Kass-Hout, Kenneth V. Snyder, L. Nelson Hopkins, Adnan H. Siddiqui, Elad I. Levy

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Objective: Acute ischemic stroke due to proximal intracranial vessel occlusion is associated with poor prognosis and neurologic outcomes. Outcomes specifically in patients with stroke due to these occlusions and lower National Institutes of Health Stroke Scale (NIHSS) scores (0-7 range) have not been described previously. Methods: We retrospectively reviewed discharge outcomes (reported in our 'Get With the Guidelines-Stroke' database) in patients with an admission NIHSS score of 0-7 due to proximal intracranial large vessel occlusion (based on CT angiography results) who were excluded from receiving intravenous (IV) thrombolysis with recombinant tissue plasminogen activator and endovascular intra-arterial (IA) stroke interventions. Results: Among the 204 patients included in our analysis, younger age and lower admission NIHSS score (0-4 range) were strong predictors of good outcome (defined as ability to ambulate independently) at discharge whereas female sex was a predictor of poor outcome. There was no significant difference between cerebrovascular risk factors, speci fic sites of occlusion, or presenting symptoms and outcomes at discharge. There was great variability in functional outcomes at discharge and discharge disposition (home versus acute or subacute facility or nursing home versus death/hospice) with a trend toward worse outcomes in patients with higher (5-7 range) NIHSS scores on admission. Conclusions: Patients with acute stroke due to large vessel occlusion and low admission NIHSS scores (0-7 range) may have poor functional outcomes at discharge. These patients, if not eligible for IV thrombolysis, might benefit from IA revascularization therapies.

Original languageEnglish (US)
Pages (from-to)413-417
Number of pages5
JournalJournal of NeuroInterventional Surgery
Volume6
Issue number6
DOIs
StatePublished - 2014
Externally publishedYes

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National Institutes of Health (U.S.)
Stroke
Hospices
Patient Admission
Tissue Plasminogen Activator
Nursing Homes
Nervous System
Databases
Guidelines

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology
  • Medicine(all)

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Outcomes in patients with acute ischemic stroke from proximal intracranial vessel occlusion and NIHSS score below 8. / Mokin, Maxim; Masud, Muhammad W.; Dumont, Travis M; Ahmad, Ghasan; Kass-Hout, Tareq; Snyder, Kenneth V.; Hopkins, L. Nelson; Siddiqui, Adnan H.; Levy, Elad I.

In: Journal of NeuroInterventional Surgery, Vol. 6, No. 6, 2014, p. 413-417.

Research output: Contribution to journalArticle

Mokin, Maxim ; Masud, Muhammad W. ; Dumont, Travis M ; Ahmad, Ghasan ; Kass-Hout, Tareq ; Snyder, Kenneth V. ; Hopkins, L. Nelson ; Siddiqui, Adnan H. ; Levy, Elad I. / Outcomes in patients with acute ischemic stroke from proximal intracranial vessel occlusion and NIHSS score below 8. In: Journal of NeuroInterventional Surgery. 2014 ; Vol. 6, No. 6. pp. 413-417.
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AU - Masud, Muhammad W.

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AU - Ahmad, Ghasan

AU - Kass-Hout, Tareq

AU - Snyder, Kenneth V.

AU - Hopkins, L. Nelson

AU - Siddiqui, Adnan H.

AU - Levy, Elad I.

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N2 - Objective: Acute ischemic stroke due to proximal intracranial vessel occlusion is associated with poor prognosis and neurologic outcomes. Outcomes specifically in patients with stroke due to these occlusions and lower National Institutes of Health Stroke Scale (NIHSS) scores (0-7 range) have not been described previously. Methods: We retrospectively reviewed discharge outcomes (reported in our 'Get With the Guidelines-Stroke' database) in patients with an admission NIHSS score of 0-7 due to proximal intracranial large vessel occlusion (based on CT angiography results) who were excluded from receiving intravenous (IV) thrombolysis with recombinant tissue plasminogen activator and endovascular intra-arterial (IA) stroke interventions. Results: Among the 204 patients included in our analysis, younger age and lower admission NIHSS score (0-4 range) were strong predictors of good outcome (defined as ability to ambulate independently) at discharge whereas female sex was a predictor of poor outcome. There was no significant difference between cerebrovascular risk factors, speci fic sites of occlusion, or presenting symptoms and outcomes at discharge. There was great variability in functional outcomes at discharge and discharge disposition (home versus acute or subacute facility or nursing home versus death/hospice) with a trend toward worse outcomes in patients with higher (5-7 range) NIHSS scores on admission. Conclusions: Patients with acute stroke due to large vessel occlusion and low admission NIHSS scores (0-7 range) may have poor functional outcomes at discharge. These patients, if not eligible for IV thrombolysis, might benefit from IA revascularization therapies.

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