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Delphi Consensus on Early Neurologic Improvement after Mechanical Thrombectomy.

Cem Bilgin1, Johanna Ospel2, Hassan Kobeissi3,4

  • 1From the Department of Radiology (C.B., H.K., S.G., E.A.B., W.B., D.F. K.), Mayo Clinic, Rochester, Minnesota Bilgin.cem@mayo.edu.

AJNR. American Journal of Neuroradiology
|April 2, 2026
PubMed
Summary

Experts reached a consensus on a unified definition for early neurologic improvement (ENI) after mechanical thrombectomy (MT). A standardized ENI definition, focusing on functional independence, is crucial for clinical practice and stroke research.

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Area of Science:

  • Neurology
  • Stroke Medicine
  • Clinical Trials

Background:

  • Early neurologic improvement (ENI) after mechanical thrombectomy (MT) lacks a standardized definition, hindering clinical practice and research.
  • Over 40 different ENI definitions exist, leading to significant heterogeneity and lack of consensus.
  • A Delphi study was conducted to investigate expert perspectives on ENI definitions and achieve consensus.

Purpose of the Study:

  • To investigate expert perspectives on existing early neurologic improvement (ENI) definitions following mechanical thrombectomy (MT).
  • To determine if a consensus can be achieved on a unified ENI definition.
  • To identify the key components of a standardized ENI definition for clinical and research applications.

Main Methods:

  • A Delphi approach involving 20 neurointerventional experts was employed.
  • Systematic literature review followed by three rounds of anonymous web-based surveys.
  • Consensus was defined as ≥70% agreement for binary questions and ≥50% for multi-option questions.

Main Results:

  • Experts identified definition heterogeneity as a major limitation in using ENI.
  • Consensus was reached that a unified ENI definition should predict functional independence at 3 months.
  • A unified ENI definition of NIHSS improvement ≥8 points at 24 hours was agreed upon.
  • Experts agreed that incorporating comorbidities or baseline severity would complicate the definition.

Conclusions:

  • Experts agreed on a unified ENI definition: NIHSS improvement ≥8 points at 24 hours.
  • Consensus was not reached on using ENI as a primary endpoint in MT trials.
  • Further prospective studies are needed to validate ENI definitions and assess prognostic utility in specific scenarios.