Correlation Study Between Early Neurological Change And Prognosis Of Patients With Acute Ischemic Stroke Undergoing Endovascular Therapy As Well As Its Predictors

Background:Previous studies demonstrated a clinical benefit of endovascular therapy(ET)over best medical therapy(including IV thrombolysis)in selected patients with acute stroke due to proximal occlusion in the carotid territory.Endovascular stent thrombectomy(EST)is now the new standard of care for acute large vessel ischemic stroke.A reliable surrogate at 24 hours after treatment to predict long-term outcome in patients with acute ischemic stroke(AIS)is of great value.Thus,our study aimed to identify predictors of early neurological change at 24 hours in patients with AIS after ET as well as the relationship between early neurological change and clinical outcome at 3 months.Methods:We first retrospectively reviewed 98 consecutive patients with AIS treated with ET(intra-arterial thrombolysis + mechanical thrombectomy).Then,97 consecutive patients with AIS who received EST were retrospectively reviewed.Data on demographics,pre-existing vascular risk factors,National Institutes of Health Stroke Scale(NIHSS)score on admission as well as 24 hours after the endovascular procedurals,pre-and post-treatment modified Treatment in Cerebral Ischemia(mTIC1)classification and collaterals were collected.A 3-month functional outcome was assessed using the modified Rankin Scale(mRS).LOI was defined as a reduction of 3 points or less on the NIHSS at 24 hours compared with baseline.Percent improvement was defined as([baseline NIHSS score-24-hour NIHSS score]/baseline NIHSS score × 100%),while absolute improvement was calculated by the difference between scores(baseline NIHSS score minus 24-hour NIHSS score).Areas under the receiver-operating characteristic(ROC)curve(AUC)for percent improvement and absolute improvement in predicting favorable 3-month stroke outcome was compared.The cutoff point was determined with the largest Youden index of the ROC.RNI was defined as neurological improvement ? the cutoff value.A logistic regression model was used to identify the association between LOI,RNI and 24-hour NIHSS and clinic outcome and their predictors.Results:(1)Poor collaterals(p=0.012)and time to reperfusion beyond 6 hours(p=0.002)were independently predictive of LOI.High admission NIHSS score(p=0.002),LOI(p<0.001)and poor collaterals(p=0.048)were independent predictors of unfavorable outcome at 3 months.(2)Pairwise comparison of ROC curves revealed that percent improvement had larger AUC than absolute improvement(p =0.004).Good collaterals(p = 0.030)and time to reperfusion within 6 hours(p = 0.022)were independently predictive of RNI.Good collaterals(p = 0.006)were independent predictors of favorable outcome,while high admission NIHSS score(p = 0.022)was an independent predictors of unfavorable outcome.(3)The predictive power of the 24-hour NIHSS alone for 3-month favorable outcome was excellent(AUC=0.882).Percent improvement(AUC =0.859)and absolute improvement(AUC =0.800)had lower predictive powers for favorable outcome as compared to the 24-hour NIHSS.High 24-hour NIHSS score(p<0.001)was an independent predictor of unfavorable outcome,while good collaterals(p=0.038)was an independent predictor of favorable outcome.Conclusions:(1)Among patients with AIS treated with ET,as an independent predictor of unfavorable outcome,LOI at 24 hours is associated with poor collaterals and time to reperfusion beyond 6 hours.(2)Percent improvement in NIHSS scores between baseline and 24 hours predicted 3-month favorable outcome in AIS patients treated with EST.Good collaterals and time to reperfusion within 6 hours are independent predictors of RNI.(3)The 24-hour clinical examination using the NIHSS strongly predicts 3-month functional independence.