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Decision-Making for Endovascular Thrombectomy in Patients With Large Vessel Occlusions and Mild Neurological Deficit

2025-09Recensão Acesso aberto
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dc.contributor.authorBosshart, Salome L.
dc.contributor.authorKappelhof, Manon
dc.contributor.authorStebner, Alexander
dc.contributor.authorFujiwara, Satoru
dc.contributor.authorCimflova, Petra
dc.contributor.authorSchüngel, Marie Sophie
dc.contributor.authorMilot, Genevieve
dc.contributor.authorMosimann, Pascal J.
dc.contributor.authorSchaafsma, Joanna D.
dc.contributor.authorRibo, Marc
dc.contributor.authorPaul, Alexandra R.
dc.contributor.authorUlfert, Christian
dc.contributor.authorAlmekhlafi, Mohammed
dc.contributor.authorFragata, Isabel
dc.contributor.authorFragata, Isabel
dc.contributor.authorNardai, Sandor
dc.contributor.authorLopes, Demetrius K.
dc.contributor.authorMenon, Bijoy
dc.contributor.authorBhogal, Pervinder
dc.contributor.authorPensato, Umberto
dc.contributor.authorHawkes, Christine
dc.contributor.authorYoshimura, Shinichi
dc.contributor.authorInoa, Violiza
dc.contributor.authorGanesh, Aravind
dc.contributor.authorSingh, Nishita
dc.contributor.authorVolders, David
dc.contributor.authorMoreu, Manuel
dc.contributor.authorUchida, Kazutaka
dc.contributor.authorNimjee, Shahid
dc.contributor.authorSaver, Jeffrey L.
dc.contributor.authorHill, Michael D.
dc.contributor.authorOspel, Johanna M.
dc.contributor.institutionNOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
dc.contributor.pblKorean Stroke Society
dc.date.accessioned2025-12-05T21:16:00Z
dc.date.available2025-12-05T21:16:00Z
dc.date.issued2025-09
dc.descriptionPublisher Copyright: t © 2025 Korean Stroke Society.
dc.description.abstractAcute ischemic stroke patients with mild deficits (National Institutes of Health Stroke Scale [NIHSS] of 0–5) but confirmed large vessel occlusions (LVO) present a clinical challenge for endovascular thrombectomy (EVT) decisions due to limited evidence and the absence of clear guidelines. A Delphi consensus was conducted at the 2024 5T (Teamwork, Training, Technology, Technique, Transport) Think Tank conference with 40 international stroke experts. Following a systematic literature review, three iterative Delphi rounds were employed to explore EVT decisionmaking in strokes due to LVO with low NIHSS. Data were collected through surveys and in-person discussions, focusing on disability evaluation, imaging markers, procedural risk, and outcome scales. Consensus was achieved on key factors influencing EVT decisions. Experts emphasized the importance of symptom-specific disability (e.g., aphasia, vision loss) over NIHSS scores alone. Early neurological deterioration (END) was perceived as main concern in this patient population. Imaging markers such as proximal occlusion, poor collaterals, and large penumbra were expected to be predictors of END. The anticipated technical difficulty and patient-specific factors, such as independence and quality of life, also guided decisions. The Potential of rtPA for Ischemic Strokes With Mild Symptoms (PRISMS) trial definition of disabling deficits and the 9-level modified Rankin Scale were favored as outcome measures for future studies. EVT decisions for acute ischemic strokes with mild deficit but proven LVO require nuanced, individualized approaches beyond NIHSS thresholds. Disability assessment, imaging-based risk evaluation, and patient-centered discussions are critical for optimizing outcomes, emphasizing the need for further research and standardized guidelines.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent12
dc.format.extent140960
dc.identifier.doi10.5853/jos.2025.00304
dc.identifier.issn2287-6391
dc.identifier.otherPURE: 136264186
dc.identifier.otherPURE UUID: 3b3bb091-0a0a-403d-8a68-3d3899be14da
dc.identifier.otherScopus: 105019955612
dc.identifier.urihttp://hdl.handle.net/10362/191560
dc.identifier.urlhttps://www.scopus.com/pages/publications/105019955612
dc.language.isoeng
dc.peerreviewedyes
dc.subjectEarly neurological deterioration
dc.subjectLarge-vessel occlusion
dc.subjectLow NIHSS
dc.subjectMild deficit
dc.subjectStroke
dc.subjectThrombectomy
dc.subjectClinical Neurology
dc.subjectCardiology and Cardiovascular Medicine
dc.titleDecision-Making for Endovascular Thrombectomy in Patients With Large Vessel Occlusions and Mild Neurological Deficiten
dc.title.subtitleA Consensus Statementen
dc.typereview
degois.publication.firstPage338
degois.publication.issue3
degois.publication.lastPage349
degois.publication.titleJournal of Stroke
degois.publication.volume27
dspace.entity.typePublication
person.familyNameFragata
person.givenNameIsabel
person.identifier.ciencia-id731B-55AF-48F0
person.identifier.orcid0000-0002-7037-7458
person.identifier.scopus-author-id57193217495
rcaap.rightsopenAccess
relation.isAuthorOfPublication91e830b1-66a1-46f1-8fb8-8f4af1696f1d
relation.isAuthorOfPublication.latestForDiscovery91e830b1-66a1-46f1-8fb8-8f4af1696f1d

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