Details

Autor(en) / Beteiligte

• Hendrix, Philipp
• Melamed, Itay
• Collins, Malie
• Lieberman, Noah
• Sharma, Vaibhav
• Goren, Oded
• Zand, Ramin

Titel

NIHSS 24â¯h After Mechanical Thrombectomy Predicts 90-Day Functional Outcome

Ist Teil von

• Clinical neuroradiology (Munich), 2022-06, Vol.32 (2), p.401

Ort / Verlag

Springer

Erscheinungsjahr

2022

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• Background Mechanical thrombectomy (MT) for large vessel occlusion (LVO) ischemic stroke is a safe and effective treatment modality. The National Institute of Health Stroke Scale (NIHSS) 24â¯h after MT (24â¯h-NIHSS) was shown to serve as the strongest surrogate for 90-day functional outcome. Here, we seek to externally validate 24â¯h-NIHSS as predictor for 90-day functional outcome and explore additional variables in this context. Methods Patients treated for anterior LVO between February 2016 and August 2020 with premorbid mRSâ¯< 3 were included. Receiver operating characteristics were used to compare different NIHSS-related surrogates, such as baseline (B) NIHSS, 24â¯h-NIHSS, [DELTA]âNIHSS and percent (%) change NIHSS to predict favorable function outcome (mRS 0-2). Additional analysis was performed to assess predictors associated with poor outcome despite reaching the best predictor threshold. Results A total of 337 eligible cases were identified. The 24â¯h-NIHSS outperformed BâNIHSS, [DELTA]âNIHSS, and %âNIHSS in terms of 90-day mRS 0-2 prediction. A 24-NIHSSâ¯[less than or equal to] 8 was identified as the optimal binary threshold. Multivariable analysis demonstrated that 24-NIHSSâ¯[less than or equal to] 8 and younger patient age were independently associated with mRS 0-2. Despite achieving 24â¯h-NIHSSâ¯[less than or equal to] 8, 23/143 (16.1%) cases experienced poor outcome (mRS 4-6). Older age, higher baseline NIHSS, coexisting chronic kidney disease, and longer hospital stay were independent predictors for poor outcome despite achieving 24â¯h-NIHSSâ¯[less than or equal to] 8. Conclusion An NIHSS of 8 or less 24â¯h after MT was validated to serve as an independent, strong surrogate for favorable functional outcome; however, cofactors such as older age, higher baseline NIHSS and coexisting comorbidities appear to mitigate this clinical adjunct.