Minor stroke in large vessel occlusion: Matched analysis of German Stroke Registry thrombectomy patients with Safe Implementation of Treatment in Stroke registry thrombolysis patients

Reperfusion treatment in patients presenting with large vessel occlusion (LVO) and minor neurological deficits is still a matter of debate. We aimed to compare minor stroke patients treated with endovascular thrombectomy (EVT) and intravenous thrombolysis (IVT) or IVT alone.Patients enrolled in the German Stroke Registry-Endovascular Treatment (GSR-ET) and SITS International Thrombolysis Registry between 06/2015 and 12/2019 were analyzed. Minor stroke was defined as National Institutes of Health Stroke Scale (NIHSS) ≤ 5, and LVO as occlusion of the internal carotid, carotid-T, middle cerebral, basilar, vertebral and posterior cerebral arteries. GSR-ET and SITS-IVT patients were matched in a 1:1 ratio using propensity score matching (PSM). Primary outcome was good functional outcome at 3-months (modified Rankin Scale of 0-2).272 GSR-ET-patients treated with EVT and IVT (age 68.6±14.0, 43.4% female, NIHSS 4 [2-5]) were compared to 272 IVT-treated SITS-patients (age 69.4±13.7, 43.4% female, NIHSS 4 [2-5]). Good functional outcome was seen in 77.0% vs 82.9% (p=0.119), mortality in 5.9% vs 7.9% (p=0.413), and intracranial hemorrhage in 8.8% vs 12.5% (p=0.308) in GSR-ET and SITS-IVT, respectively. In a second PSM analysis, 624 GSR-ET-patients (IVT-rate 56.7%) and 624 SITS patients (IVT-rate 100%), good outcome was more often observed in SITS (68.2% vs. 80.9%, p<0.001), and IVT independently predicted good outcome (OR 2.16, 95% CI 1.43-3.28).Our study suggests similar effectiveness of IVT alone compared to EVT with or without IVT in minor stroke patients. There is an urgent need for randomized controlled trials on this topic.