AUTHOR=Duloquin Gauthier , Crespy Valentin , Jakubina Pauline , Giroud Maurice , Vergely Catherine , Béjot Yannick 

TITLE=Large Vessel Occlusion in Patients With Minor Ischemic Stroke in a Population-Based Study. The Dijon Stroke Registry

JOURNAL=Frontiers in Neurology

VOLUME=Volume 12 - 2021

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.796046

DOI=10.3389/fneur.2021.796046

ISSN=1664-2295

ABSTRACT=Introduction: Strategy for the acute management of minor ischemic stroke (IS) with large vessel occlusion (LVO) is under debate, especially the benefits of mechanical thrombectomy. The frequency of minor IS with LVO among overall patients is not well established. This study aimed to assess the proportion of minor IS, and to depict characteristics of patients according to the presence of LVO, in a comprehensive population-based setting.
Methods: Patients with acute IS were prospectively identified among residents of Dijon, France, using a population-based registry (2013-2017). All arterial imaging exams were reviewed to assess arterial occlusion. Minor stroke was defined as NIHSS score <6. Proportion of patients with LVO was estimated in the minor IS population. The clinical presentation of patients was compared according to the presence of a LVO.
Results:  971 patients were registered, including 582 (59.9%) patients with a minor IS. Of these patients 23 (4.0%) had a LVO. Patients with minor IS and LVO had more severe presentation (median 3 [IQR 2-5] versus 2 [IQR 1-3], p=0.001), more often decreased consciousness (13.0% versus 1.6%, p<0.001), and more often cortical signs (56.5% versus 30.8%, p=0.009) especially aphasia (34.8% versus 15.4%, p=0.013) and altered item LOC questions (26.1% versus 11.6%, p=0.037). In multivariable analyses, only NIHSS score (OR=1.45 per each point; 95% CI: 1.11-1.91, p=0.007) was associated with proximal LVO in patients with minor IS.
Conclusion: LVO in minor stroke is non-exceptional, and our findings highlight the need for emergency arterial imaging in any patients suspected of acute stroke, including those with minor symptoms because of the absence of obvious predictors of proximal LVO.