Abstract
Although revascularization rates after endovascular thrombectomy for large vessel acute ischemic stroke (AIS) are high (71%), only 46% of patients achieve functional independence at 90 days. The present study was designed to explore a new method for predicting the functional prognosis of AIS patients after endovascular recanalization. A total of 200 anterior circulation stroke patients who received endovascular therapy were enrolled. Logistic regression analysis of clinical characteristics on functional independence were performed. The predictive power of sub-items in National Institute of Health stroke scale (NIHSS) and the combination of NIHSS consciousness and Alberta Stroke Program Early CT Score (ASPECTS) on functional independence were assessed by Receiver Operating Characteristic (ROC) curves and the latter was compared with 3 previously published prediction models by AUC (the area under ROC curve). The AUC for the NIHSS consciousness score to predict functional independence was higher than whole NIHSS and other sub-items (0.716 v 0.705, 0.586, 0.573, 0.552 and 0.559). Low NIHSS consciousness score, high ASPECTS score, short time from onset to recanalization, and high rate of successful recanalization were demonstrated to be significantly associated with the functional independence (OR 0.697, 2.226, 0.994 and 28.643). The prediction power of the combination was significantly better than NIHSS and ASPECTS alone (AUC 0.793 v 0.705 and 0.752). Compared with 3 other prediction models, the combination was found to be the strongest predictor for functional independence (AUC 0.793 v 0.791, 0.671 and 0.564). NIHSS which has been shown to be a strong predictor of functional outcomes after endovascular recanalization is largely dependent on the consciousness component. NIHSS consciousness score combined with ASPECTS appears to be a favorable predictor of functional independence. These findings may have broad reaching effects for isolated centers around the world without advanced imaging for triage and prognostication.
Highlights
Compared with intravenous intravenous recombinant tissue plasminogen activator (rt-PA), endovascular therapy occlusions (LVO) and is associated with better short and (EVT) leads to an overall higher degree of recanalization long-term prognosis [1,2,3]
This study revealed 4 main periprocedural factors, including National Institute of Health Stroke Scale (NIHSS), Alberta Stroke Program Early computed tomographic (CT) Score (ASPECTS) score, to recanalization (TOR) and thrombolysis in cerebral infarction (TICI) score which affected the prognosis of acute ischemic stroke (AIS) patients with LVO after EVT
NIHSS consciousness score combined with ASPECTS offered a powerful prediction effect for functional independence after endovascular recanalization
Summary
Compared with intravenous rt-PA, endovascular therapy occlusions (LVO) and is associated with better short and (EVT) leads to an overall higher degree of recanalization long-term prognosis [1,2,3]. Not all successfully recanalized patients progressed to pre morbid functionality after EVT with randomized trials on thrombectomy showing a 3-month mRS score (0-2) ranging from 32.6% (MR CLEAN) to 71.4% (Extend-IA) [1]. It is well-known that futile reperfusion can occur despite successful revascularization with failures to improve functional outcome [10]. We aimed to screen for these prognostic factors and explore a new method which predicts functional prognosis of AIS patients within 6 hours from stroke onset after endovascular recanalization
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