Our objective is to compare baseline characteristics and short-term clinical outcomes between stroke patients with large vessel occlusion (LVO) and low NIHSS treated with endovascular treatment (EVT) or medical management.

Current American Heart Association guidelines strongly recommend EVT for acute ischemic stroke (AIS) patients with LVO and NIHSS score of ≥6. Although EVT for stroke patients with NIHSS <5 is safe, it is not common in clinical practice. Our study explores the impact of these two treatment options while also comparing patient baseline characteristics.

We conducted a retrospective analysis of 920 stroke patients. Patients were stratified into EVT (n=75, 8.1%) and medical management (n=845, 91.9%) groups. Baseline demographics, comorbidities, and stroke characteristics were compared. Primary outcomes included excellent functional outcome (mRS 0–1), good functional outcome (mRS 0–2), and discharge to home. Logistic regression models adjusted for age, sex, NIHSS, baseline mRS, thrombolytic use, and selected comorbidities.

EVT patients were slightly younger (mean 61.5 vs 64.0 years, p=0.187), with higher baseline NIHSS scores (median 4 vs 2, p<0.001). Compared to medical management, EVT patients had lower rates of coronary artery disease (12.0% vs 22.0%, p=0.042), carotid stenosis (6.7% vs 15.7%, p=0.035), and diabetes (18.7% vs 29.7%, p=0.043), but higher prevalence of obesity (80.0% vs 67.7%, p=0.028).

On univariate analysis, EVT was not significantly associated with excellent outcome (OR 1.17, 95% CI 0.72–1.88, p=0.530), good outcome (OR 1.14, 95% CI 0.69–1.88, p=0.621), or discharge home (OR 0.67, 95% CI 0.41–1.08, p=0.103). Adjusted analyses confirmed the absence of significant differences in outcomes between EVT and medical groups.