Abstract
Background and PurposeGood clinical outcome predictors have been established in mechanical thrombectomy (MT) for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). An early neurological improvement (ENI), defined as a reduction of ≥8 on the National Institutes of Health Stroke Scale (NIHSS), compared with the baseline score or an NIHSS of 0 or 1 at 24 h after MT, is a strong predictor of favorable outcome. We aimed to study the impact of ENI after MT for distal medium vessel occlusions (DMVO).MethodsWe retrospectively analyzed the data of consecutive patients who underwent MT for a primary DMVO in one large academic center. We compared clinical outcomes between patients with DMVO stratified by ENI. Multivariate analyses were performed to determine the impact of ENI on good 90-day outcome (modified Rankin scale of 0–2) and identify factors contributing to ENI.ResultsBetween January 2018 and January 2021, 61 patients underwent an MT for an AIS with a primary DMVO. An ENI was seen in 24 (39%) patients (ENI+). Outcomes were significantly better in ENI+ patients, with 83% achieving a good outcome at 3 months vs. 43% for patients without ENI (ENI–; p = 0.019). ENI was an independent predictive factor of good clinical outcome even after adjusting for potential confounding factors [odds ratio 12.49 (1.49–105.01), p = 0.020]. The use of intravenous tissue plasminogen activator [IVtPA; Odds-ratio 6.59 (1.82–23.89), p = 0.004] was a positive predictor of ENI.ConclusionENI at day 1 following MT for DMVO stroke is a strong independent predictor of good to excellent 3-month clinical outcome.
Highlights
It has been demonstrated that early neurological improvement (ENI) after mechanical thrombectomy (MT) or administration of Intravenous tissue Plasminogen Activator (IVtPA) for an anterior acute ischemic stroke (AIS) is a solid predictor of favorable long-term outcome [1–4]
While there are some data on predictors of a good clinical outcome [9, 12], the effect of Early neurological improvement (ENI) remains unstudied in this population
Using the data from one large stroke center, we aimed to study the incidence and effect of ENI in patients with DMVO undergoing MT along with factors associated with ENI
Summary
It has been demonstrated that early neurological improvement (ENI) after mechanical thrombectomy (MT) or administration of Intravenous tissue Plasminogen Activator (IVtPA) for an anterior acute ischemic stroke (AIS) is a solid predictor of favorable long-term outcome [1–4]. This is applicable in late time windows [5] and for basilar artery occlusions [6]. Good clinical outcome predictors have been established in mechanical thrombectomy (MT) for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). We aimed to study the impact of ENI after MT for distal medium vessel occlusions (DMVO)
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