1Adrien Guenego, ,1Boris Lubicz
Good 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 hours 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).
Material(s) and Method(s):
We retrospectively analyzed the data of consecutive patients who underwent MT for a primary DMVO in one large academic center. We compared clinical outcomes between DMVO patients 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.
Between January 2018 and January 2021, 61 patients underwent a 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 versus 43% for ENI- patients (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). Use of IVtPA (Odds-ratio 6.59 [1.82-23.89], p=0.004) was a positive predictor of ENI.
ENI at day 1 following MT for DMVO stroke is a strong independent predictor of good to excellent 3-months clinical outcome.