Mechanical thrombectomy has become gold standard of care in large vessel occlusion after publication of the five randomized trials in 2015. In patients with major neurological deficit the mechanical thrombectomy is, without a doubt the most effective treatment in large vessel occlusion. But if patients with minor neurological deficit reflected by NIHSS ≤ 5 and large vessel occlusion also profit from mechanical thrombectomy remains uncertain.
In this study we retrospectively analyzed the data of the stroke databases of two major hospitals with high through put Stroke Units in Germany regarding the question if patients with a low NHISS ≤ 5 would benefit from mechanical thrombectomy compared to iv-rtPA alone, or no recanalizing treatment at all. We collected the neurological data as well as the baseline characteristics such as the cardiovascular risk factors.
In total 94 patients met the inclusion criteria with a large vessel occlusion and a minor neurological deficit ≤ 5. 53 of patients underwent mechanical thrombectomy and 41 patients did receive intravenous thrombolysis alone or no treatment.  No difference was observed in NHISS at admission (4 (IQR 3-5) vs. 4 (IQR 3-5); (p = 0.429)). Regarding the cardiovascular risk factors, more patients with a mechanical thrombectomy suffered from diabetes (17(32.1%) vs. 5(12.2%); p=0.028). The other cardiovascular risk factors showed no significant difference between the two groups. Interestingly there was no significant difference in the modified Rankin Scale at discharge between both groups (1 (IQR 0-2.5) vs. 1 (IQR 0-3); p = 0.620). 
The multivariate regression analysis could not show a benefit for the mechanical thrombectomy in patients with a minor stroke (RR: 0.021; 95% CI: -0.169 – 0.212; p=0.824).

THE OUTCOME OF PATIENTS WITH A MINOR STROKE IN LARGE VESSEL OCCLUSION IS NOT AFFECTED BY MECHANICAL THROMBECTOMY