Should ischemic stroke patients with aphasia or high National Institutes of Health stroke scale score undergo preprocedural intubation and endovascular treatment?

J Stroke Cerebrovasc Dis. 2014 May-Jun;23(5):e299-304. doi: 10.1016/j.jstrokecerebrovasdis.2013.12.009. Epub 2014 Feb 12.


Background: Presence of aphasia or severe neurologic deficits is considered an indication for preprocedural intubation (PPI) for endovascular treatment (ET) in acute ischemic stroke patients. We determined the feasibility, technical success rates, and outcomes of ET without PPI in 2 groups of patients: those with aphasia and those with an admission NIHSS score of 20 or more.

Methods: The rates of intraprocedural intubation (IPI), good functional outcome at discharge (modified Rankin Scale score of 0-2), mortality, and intracerebral hemorrhage (ICH) were compared between those who did or did not undergo PPI in the above-mentioned patient groups.

Results: A total of 60 (50%) of 120 patients with aphasia underwent ET without PPI; 6 of 60 patients required IPI. The odds of any ICH (odds ratio [OR] 6.3) and in-hospital mortality (OR 9.3) were significantly higher in those undergoing PPI. In the second analysis, 36 (39%) of 93 patients with an NIHSS score of 20 or more underwent ET without PPI; 6 of 57 patients required IPI. The risk of any ICH (OR 7.6) and in-hospital mortality (OR 5.0) was higher among patients who underwent PPI. The rates of good outcome at discharge were significantly lower among patients with aphasia (OR .1, 95% confidence interval [CI] .04-.2) or those with an NIHSS score of 20 or more (OR .07, 95% CI .005-.9) with PPI compared with those without PPI.

Conclusions: Despite the risk of IPI, patients with aphasia or an admission NIHSS score of 20 or more who underwent ET with PPI had lower rates of good outcomes and higher rates of ICH and death.

Keywords: Ischemic stroke; NIHSS score; aphasia; endovascular treatment; mechanical thrombectomy; preprocedural intubation.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aphasia / diagnosis
  • Aphasia / etiology*
  • Aphasia / mortality
  • Brain Ischemia / complications
  • Brain Ischemia / diagnosis
  • Brain Ischemia / mortality
  • Brain Ischemia / therapy*
  • Cerebral Hemorrhage / etiology
  • Cerebral Hemorrhage / mortality
  • Chi-Square Distribution
  • Disability Evaluation*
  • Endovascular Procedures* / adverse effects
  • Endovascular Procedures* / mortality
  • Feasibility Studies
  • Female
  • Hospital Mortality
  • Humans
  • Intubation, Intratracheal* / adverse effects
  • Intubation, Intratracheal* / mortality
  • Logistic Models
  • Male
  • Middle Aged
  • Odds Ratio
  • Patient Admission
  • Patient Selection
  • Predictive Value of Tests
  • Recovery of Function
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Stroke / complications
  • Stroke / diagnosis
  • Stroke / mortality
  • Stroke / therapy*
  • Time Factors
  • Treatment Outcome