Safety and Outcome of Endovascular Treatment for Minor Ischemic Stroke: Results From the Multicenter Clinical Registry of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands

J Stroke Cerebrovasc Dis. 2019 Mar;28(3):542-549. doi: 10.1016/j.jstrokecerebrovasdis.2018.10.029. Epub 2018 Dec 6.


Goal: Insufficient data is available about safety and efficacy of endovascular treatment (EVT) in patients with minor stroke symptoms because these patients were excluded from most randomized trials. We aimed to compare characteristics, functional outcome, and complications in patients with minor ischemic stroke National Institutes of Health Stroke Scale score ≤5 (NIHSS score ≤5) and moderate to severe ischemic stroke (NIHSS score ≥6) due to intracranial proximal artery occlusion of the anterior circulation who underwent EVT.

Materials and methods: We report patients with an anterior circulation occlusion who were included between March 2014 and June 2016 in the multicenter randomized clinical trial of EVT of acute ischemic stroke in the Netherlands Registry, a prospective, multicenter, observational study for stroke centers that perform EVT in the Netherlands. Minor ischemic stroke was defined as baseline NIHSS score of 5 or less. Primary outcome is the modified Rankin Scale (mRS) score at 90 days. Secondary outcomes include symptomatic intracranial hemorrhage (sICH) and mortality.

Findings: Seventy-one (5.5%) patients had a NIHSS score of 5 or less. Functional independence (mRS 0-2 at 90 days) was reached in 75% of these patients, compared to 40% of patients with NIHSS score of 6 or more. sICH occurred in 4% of patients, of which 1% occurred peri-interventionally. Death occurred in 6% of patients.

Conclusions: Patients with minor ischemic stroke with an intracranial proximal arterial occlusion of the anterior circulation who underwent EVT have a high chance of favorable outcome and appear to have low occurrence of treatment-related sICH. Therefore, our results encourage the use of EVT for minor ischemic stroke in the absence of effect estimates from controlled studies.

Keywords: Ischemic stroke; endovascular treatment; large vessel oclusion; minor symptoms.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Aged
  • Brain Ischemia / diagnosis
  • Brain Ischemia / mortality
  • Brain Ischemia / physiopathology
  • Brain Ischemia / therapy*
  • Cerebrovascular Circulation
  • Clinical Decision-Making
  • Disability Evaluation
  • Endovascular Procedures* / adverse effects
  • Endovascular Procedures* / mortality
  • Female
  • Humans
  • Intracranial Hemorrhages / etiology
  • Male
  • Middle Aged
  • Netherlands
  • Patient Selection
  • Prospective Studies
  • Recovery of Function
  • Registries
  • Risk Factors
  • Severity of Illness Index
  • Stroke / diagnosis
  • Stroke / mortality
  • Stroke / therapy*
  • Time Factors
  • Treatment Outcome