{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T02:00:53Z","timestamp":1790388053665,"version":"4.1.0"},"reference-count":40,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Endovascular thrombectomy (EVT) for acute large-vessel occlusion stroke is well established, yet its role in patients presenting with minor stroke symptoms (National Institutes of Health Stroke Scale [NIHSS] score &lt; 6) remains unclear. Prior studies have not accounted for intraprocedural factors that may influence outcomes in this subgroup.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors analyzed 5693 patients from the STAR (Stroke and Thrombectomy and Aneurysm Registry), including 398 with low NIHSS scores, to evaluate the association between procedure time (PT) and outcomes. Among patients with low NIHSS scores, propensity score matching was used to compare outcomes between those with PT \u2264 35 versus &gt; 35 minutes, a cutoff defined using receiver operating characteristic curve analysis. The authors performed a meta-analysis of studies reporting best medical management (BMM) outcomes in patients with low NIHSS scores. To compare these with EVT-treated patients, a matched BMM comparator cohort using stratification on pooled baseline characteristics was constructed. Outcomes included 90-day functional independence (modified Rankin Scale [mRS] scores 0\u20132), intracranial hemorrhage, and mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>PT had a stronger negative effect on outcomes in patients with low NIHSS scores compared with those with high scores, with a steeper decline in functional independence per minute of PT (slope: \u20130.45% vs \u20130.21%; p = 0.03 for interaction). Among patients with low scores, PT \u2264 35 minutes was associated with higher 90-day functional independence compared with the propensity score\u2013matching cohort with PT &gt; 35 minutes (82.6% vs 59.0%, p &lt; 0.001). When benchmarked against BMM (75.2% mRS scores 0\u20132), patients undergoing EVT within 35 minutes had superior outcomes (85.1%, p = 0.047). In contrast, EVT with PT &gt; 35 minutes resulted in worse outcomes than BMM (mRS scores 0\u20132: 59.8%, p = 0.008). The number needed to treat for PT \u2264 35 minutes was 10, whereas PT &gt; 35 minutes yielded a number needed to harm of 6.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>PT critically modulates the benefit of EVT in minor stroke. While efficient EVT yields better outcomes than BMM, prolonged procedures are associated with harm. These findings may explain prior inconsistent evidence on EVT in patients with low NIHSS scores and underscore the need to individualize procedural thresholds in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.2.jns252558","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:37Z","timestamp":1784073637000},"page":"1-12","source":"Crossref","is-referenced-by-count":0,"title":["Minor stroke, major stakes: impact of procedure duration on thrombectomy outcomes in minor stroke"],"prefix":"10.3171","author":[{"given":"Rahim","family":"Abo Kasem","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bachar","family":"El Baba","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Emory University School of Medicine, Atlanta;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianwen","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Zelmanovich","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Emory University School of Medicine, Atlanta;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aqueel","family":"Pabaney","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Emory University School of Medicine, Atlanta;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy","family":"Raheb Khelo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Emory University School of Medicine, Atlanta;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Giraudo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Emory University School of Medicine, Atlanta;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariana","family":"Chacon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Emory University School of Medicine, Atlanta;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Chandler","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Emory University School of Medicine, Atlanta;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sameh Samir","family":"Elawady","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reda","family":"Chalhoub","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Emory University School of Medicine, Atlanta;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian M.","family":"Howard","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Emory University School of Medicine, Atlanta;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R.","family":"Levitt","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Washington, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramesh","family":"Grandhi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Utah, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Mascitelli","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Texas Health Science Center at San Antonio, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles Michael","family":"Cawley","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Emory University School of Medicine, Atlanta;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feras","family":"Akbik","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Emory University School of Medicine, Atlanta;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zvipo","family":"Chisango","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Emory University School of Medicine, Atlanta;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey","family":"Quintero Wolfe","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Wake Forest Baptist Health, Winston-Salem, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joon-Tae","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Jabbour","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinichi","family":"Yoshimura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilko","family":"Maier","sequence":"additional","affiliation":[{"name":"Department of Neurology, Universit\u00e4tsmedizin G\u00f6ttingen, University Medicine G\u00f6ttingen, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher S.","family":"Ogilvy","sequence":"additional","affiliation":[{"name":"Neurousrgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad","family":"Ezzeldin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marios-Nikos","family":"Psychogios","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Universit\u00e4tsspital Basel, Switzerland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fazeel","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Michigan Health West, Wyoming, Michigan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro","family":"Navia","sequence":"additional","affiliation":[{"name":"Hospital Universitario La Paz, Madrid, Spain;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitin","family":"Goyal","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam S.","family":"Arthur","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele G.","family":"Romano","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, AOU San Giovanni di Dio e Ruggi d\u2019Aragona, Salerno, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Fragata","sequence":"additional","affiliation":[{"name":"NOVA Medical School, Universidade Nova de Lisboa and Centro Hospitalar Universit\u00e1rio de Lisboa Central, Lisbon, Portugal;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ergun","family":"Daglioglu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Health Science University, Ankara Bilkent City Hospital, Ankara, Turkey;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Altschul","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min S.","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Crosa","sequence":"additional","affiliation":[{"name":"M\u00e9dica Uruguaya, Montevideo, Uruguay;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waleed","family":"Brinjikji","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Moss","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Washington Regional Medical Center, Fayetteville, Arkansas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Dye","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Loma Linda University, Loma Linda, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Alaraj","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Illinois at Chicago, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Kan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaustubh","family":"Limaye","sequence":"additional","affiliation":[{"name":"Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxim","family":"Mokin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of South Florida, Tampa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M.","family":"Starke","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Miami Health System, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro M.","family":"Spiotta","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan A.","family":"Grossberg","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Emory University School of Medicine, Atlanta;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali M.","family":"Alawieh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Emory University School of Medicine, Atlanta;"},{"name":"Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"11","key":"b1","series-title":"N Engl J Med","first-page":"1019","article-title":"Randomized assessment of rapid endovascular treatment of ischemic stroke","volume":"372","author":"Goyal M","year":"2015","unstructured":"Goyal M, Demchuk AM, Menon BK,  Randomized assessment of rapid endovascular treatment of ischemic stroke. 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N Engl J Med. 2022;387(15):1373\u20131384. doi:10.1056\/NEJMoa2207576"},{"issue":"12","key":"b9","series-title":"Stroke","first-page":"e344","article-title":"Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association\/American Stroke Association","volume":"50","author":"Powers WJ","year":"2019","unstructured":"Powers WJ, Rabinstein AA, Ackerson T,  Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association\/American Stroke Association. 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J Am Heart Assoc. 2022;11(24):e027326. doi:10.1161\/JAHA.122.027326"},{"issue":"6","key":"b26","series-title":"Eur J Neurol","first-page":"1619","article-title":"Minor stroke in large vessel occlusion: a matched analysis of patients from the German Stroke Registry-Endovascular Treatment (GSR-ET) and patients from the Safe Implementation of Treatments in Stroke-International Stroke Thrombolysis Register (SITS-ISTR)","volume":"29","author":"Feil K","year":"2022","unstructured":"Feil K, Matusevicius M, Herzberg M,  Minor stroke in large vessel occlusion: a matched analysis of patients from the German Stroke Registry-Endovascular Treatment (GSR-ET) and patients from the Safe Implementation of Treatments in Stroke-International Stroke Thrombolysis Register (SITS-ISTR). 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