From the Research
A National Institutes of Health Stroke Scale (NIHSS) score of 5 does not automatically require endovascular recanalization (ER) therapy, but recent evidence suggests that mechanical thrombectomy can be safe and effective in patients with large vessel occlusions and low initial NIHSS scores. The decision for ER should be individualized based on multiple factors including the presence of a large vessel occlusion, time from symptom onset, imaging findings, and patient-specific considerations 1. While an NIHSS score of 5 indicates a moderate stroke severity, it falls in a gray zone where clinical judgment becomes crucial. Patients with NIHSS scores as low as 2 may benefit from ER if they have a documented large vessel occlusion with salvageable brain tissue.
Some key points to consider in the decision-making process include:
- The presence of a large vessel occlusion, which can be identified through imaging studies such as CT or MRI angiography 2
- The time from symptom onset, which can impact the effectiveness of ER therapy 3
- The patient's overall clinical status, including their medical history and current condition 4
- The results of perfusion imaging, which can help identify areas of salvageable brain tissue 2
Intravenous thrombolysis with alteplase (if within the appropriate time window) should still be considered as first-line therapy when appropriate, with ER as an additional or alternative option based on the complete clinical picture rather than relying solely on the NIHSS score. A multidisciplinary stroke team evaluation is essential in making this decision, taking into account the location of the occlusion, perfusion imaging results, and the patient's overall clinical status 5.