Early vs. delayed neurological improvements in acute ischemic stroke patients following endovascular treatment

Early neurological improvement (ENI) at 24 h after endovascular treatment (EVT) is a surrogate marker for predicting functional improvement of acute ischemic stroke (AIS) patients; however, using delayed neurological improvement (DNI) at seven days post-EVT remains understudied. We investigated differences between ENI and DNI in predicting functional outcome of AIS patients undergoing EVT.

We retrospectively analyzed the prospectively collected data from 187 patients undergoing EVT. ENI was defined as a reduction of more than four points on the National Institute of Health Stroke Scale (NIHSS) after 24 h compared with admission or an NIHSS of 0 or 1 after 24 h; whereas the same parameter at seven days post-EVT was defined as DNI. A favorable outcome was a modified Rankin scale (mRS) score of 0-2 after 90 days.

There were no statistically significant differences in sex, age, hypertension, diabetes, coronary artery disease, atrial fibrillation, hyperlipidemia, successful recanalization (modified thrombolysis in cerebral infarction (mTIC)=2b-3), complete recanalization (mTICI=3), pre-EVT NIHSS, bridging thrombolysis, door-to-puncture time, last-known well time, and parenchymal hematoma. 62.96 % of patients in the DNI group achieved favorable outcome compared to 78.21 % in the ENI group (p=0.118).

DNI may be used similarly to ENI to predict favorable outcomes post-EVT.