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NIHSS 24 h After Mechanical Thrombectomy Predicts 90-Day Functional Outcome
Philipp Hendrix1,2, Itay Melamed1, Malie Collins3
1Department of Neurosurgery, Geisinger, Danville, PA, USA.
Clinical Neuroradiology
|August 17, 2021
Summary
The 24-hour National Institute of Health Stroke Scale (NIHSS) score reliably predicts functional outcomes after mechanical thrombectomy for large vessel occlusion stroke. However, older age and comorbidities can impact these predictions.
Area of Science:
- Neurology
- Interventional Cardiology
- Public Health
Background:
- Mechanical thrombectomy (MT) is a key treatment for large vessel occlusion (LVO) ischemic stroke.
- The 24-hour post-MT National Institute of Health Stroke Scale (NIHSS) score is a strong predictor of 90-day functional outcomes.
- External validation of the 24-hour NIHSS and exploration of additional predictive factors are needed.
Purpose of the Study:
- To externally validate the 24-hour NIHSS as a predictor of 90-day functional outcome after MT for anterior LVO.
- To identify additional variables associated with functional outcomes, particularly in patients achieving a favorable 24-hour NIHSS score.
Main Methods:
- Retrospective analysis of 337 patients with anterior LVO treated with MT (February 2016 - August 2020), with premorbid modified Rankin Scale (mRS) < 3.
- Receiver operating characteristic (ROC) analysis to compare the predictive performance of baseline NIHSS, 24-hour NIHSS, NIHSS change, and % NIHSS change for favorable outcome (mRS 0-2).
- Multivariable analysis to identify predictors of poor outcome (mRS 4-6) despite a favorable 24-hour NIHSS score.
Main Results:
- The 24-hour NIHSS demonstrated superior prediction of 90-day functional outcome (mRS 0-2) compared to other NIHSS metrics.
- An optimal binary threshold of 24-hour NIHSS ≤ 8 was identified.
- Younger age was independently associated with favorable outcomes (mRS 0-2).
- Among patients with 24-hour NIHSS ≤ 8, 16.1% experienced poor outcomes (mRS 4-6).
- Older age, higher baseline NIHSS, chronic kidney disease, and longer hospital stay predicted poor outcomes despite a favorable 24-hour NIHSS.
Conclusions:
- The 24-hour NIHSS ≤ 8 is validated as a strong, independent predictor of favorable functional outcomes after MT for LVO.
- Factors such as older age, higher baseline NIHSS, and comorbidities can diminish the predictive value of the 24-hour NIHSS.
- These findings highlight the need to consider patient-specific factors beyond the 24-hour NIHSS for comprehensive outcome prediction.
