Intra-procedural SSEP latency stratifies functional outcome after successful endovascular thrombectomy

Area of Science:

• Neurology
• Neurosurgery
• Critical Care Medicine

Background:

• Successful reperfusion via endovascular thrombectomy (EVT) does not guarantee good functional recovery in stroke patients.
• The predictive value of intra-procedural somatosensory evoked potential (SSEP) latency dynamics for outcomes after successful EVT is not well understood.

Purpose of the Study:

• To investigate if intra-procedural SSEP latency dynamics can stratify 90-day functional outcomes in patients undergoing EVT for anterior large-vessel occlusion.
• To evaluate the reproducibility of SSEP latency dynamics as a predictive tool.

Main Methods:

• An exploratory sub-study of the COMPETE trial monitored SSEP in patients with mTICI ≥2b.
• Classification and Regression Tree analyses were performed using N20, P40, and combined N20/P40 SSEP variables.
• Bootstrap resampling (n=1000) assessed the stability of variable selection, with favorable outcome defined as mRS 0-2 at 90 days.

Main Results:

• Latency variables were stronger predictors than amplitude.
• Max ΔN20 Latency (primary analysis) and Max P40 Latency (secondary analysis) were dominant discriminators.
• These SSEP latency dynamics significantly stratified favorable outcomes, with AUC-ROC values ranging from 0.746 to 0.887.

Conclusions:

• Intra-procedural SSEP latency dynamics are associated with stratified 90-day functional outcomes in patients with successful EVT.
• SSEP latency may serve as a valuable real-time physiologic indicator during EVT.
• Prospective external validation is warranted for these promising findings.