Türk Beyin Damar Hast Derg. 2018; 24(2): 67-70 | DOI: 10.5505/tbdhd.2018.24483

Mechanical Thrombectomy for Minor Stroke Patients (NIHSS<6) With Large Vessel Occlusion

Çetin Kürþad Akpýnar¹, Erdem Gürkaþ², Emrah Aytaç³, Murat Çalýk^1
1Samsun Training and Research Hospital, Neurology Clinic, Samsun, Turkey
²Gülhane Training and Research Hospital, Neurology Clinic, Samsun, Turkey
³Department of Neurology, Fýrat University, Elazig, Turkey

INTRODUCTION: Large vessel occlusion can present with minor stroke in 30% of cases. Although the efficacy of mechanical thrombectomy in minor stroke National Institute of Health Stroke Scale (NIHSS<6) has been shown in subgroups of clinical trials, there is no randomized clinical trial focusing on this patient group.
METHODS: 8 patients (3 female, 5 male) presenting with minor stroke (NIHSS<6) with large vessel occlusion on CT angiography were included. Thrombolytic treatment was administered in 5 patients presenting in 4.5 hours. Mechanical thrombectomy was performed within 6 hours in 5 patients and in 3 patients presenting beyond 6 hours. Modified treatment in cerebral ischemia (mTICI) 2b-3 was considered as successful recanalzation, functional outcome was evaluated at 90 day.
RESULTS: 8 patients with ages between 40 and 81 years were included in the study. Successful recanalization (mTICI 2b-3) was achieved in all cases. 3 patients were not eligible for intravenous thrombolysis due to late arrival time. In these cases, after clinical deterioration occured mechanical thrombectomy was performed. 90 day mRS were 2, 4 and 5 in these 3 cases. 90 day modified Rankin Scale (mRS) were between 0-2 in all 5 patients treated within 6 hours.
DISCUSSION AND CONCLUSION: Although there are few cases, our study demonstrated that mechanical thrombectomy is more efficaceous in minor stroke patients when performed earl, as demonstrated in other studies.

Keywords: Acute stroke, large vessel occlusion, minor stroke, mechanical thrombectomy, functional outcome, NIHSS.

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Büyük Damar Oklüzyonu Olan Minör inmelerde (NIHSS <6) Mekanik Trombektomi

Çetin Kürþad Akpýnar¹, Erdem Gürkaþ², Emrah Aytaç³, Murat Çalýk^1
1Samsun Eðitim ve Araþtýrma Hastanesi, Nöroloji Kliniði, Samsun
²Gülhane Eðitim ve Araþtýrma Hastanesi, Nöroloji Kliniði, Ankara
³Fýrat Üniversitesi Týp Fakültesi, Nöroloji Anabilim Dalý, Elazýð

GÝRÝÞ ve AMAÇ: Büyük damar oklüzyonu %30 varan oranda minör inme kliniði ile baþvurabilir. Büyük damar oklüzyonu olan minör inmelerde National Institute of Health Stroke Scale (NIHSS<6) mekanik trombektominin etkinliði yapýlan çalýþmalarda gösterilsede, bu konu ile ilgili bir randomize klinik çalýþma yoktur.
YÖNTEM ve GEREÇLER: Minör inme kliniði (NIHSS<6) ile baþvuran ve beyin-boyun tomografi anjiografi tetkikinde büyük damar oklüzyonu saptanan 8 hasta (3’ü kadýn, 5’i erkek) çalýþmaya dahil edildi. Trombolitik tedavi ilk 4.5 saat içerisinde baþvuran 5 olguya verildi. Ardýþýk olarak ilk 3 hastaya geç dönemde, sonraki 5 hastaya ise erken dönemde (ilk 6 saat), mekanik trombektomi uygulandý. Baþarýlý damar rekanalizasyonu modified treatment in cerebral ischemia (mTICI) 2b-3 olarak ve klinik sonlaným 90. günde deðerlendirildi.
BULGULAR: Yaþlarý 40 ile 81 arasýnda deðiþen 8 olgu çalýþmaya dahil edildi. Tüm olgularda baþarýlý rekanalizasyon (mTICI 2b-3) saðlandý. Üç olguya sadece intravenöz trombolitik tedavi verildi. Bu olgularda takip sonrasý klinik progresyon (NIHSS>6) geliþti ve mekanik trombektomi yapýldý. Geç dönemde trombektomi yapýlan bir olgunun 90. gündeki mRS deðeri 2 diðer iki olgunun ise sýrasýyla 4 ve 5 idi. Erken dönemde mekanik tromimbektomi yapýlan 5 olgunun da 90. gündeki modified Rankin Scale (mRS) deðeri 0-2 idi.
TARTIÞMA ve SONUÇ: Çalýþmamýz az sayýda hasta içermesine raðmen literatürdeki çalýþmalarla uyumlu olarak minör inmeli bu olgularda erken dönemde mekanik trombektomi yapýlmasýnýn daha iyi klinik sonlaným ile seyrettiðini desteklemektedir.

Anahtar Kelimeler: Akut inme, büyük damar oklüzyonu, minör inme, mekanik trombektomi, klinik sonlaným, NIHSS.

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