Early surrogates of functional outcome after thrombectomy for MCA-M2 occlusions
Abstract
Abstract The National Institutes of Health Stroke Scale (NIHSS) at 24h is a strong predictor of long-term independence after mechanical thrombectomy for anterior circulation strokes. Its predictive value in patients with M2 segment of the middle cerebral artery (MCA-M2) occlusions, however, remains unclear. This study compares NIHSS scores at admission and 24h and early neurological improvement (ENI) definitions to predict functional outcomes at 90d for M2 occlusions. Patients with isolated MCA-M2 occlusions from the German Stroke Registry (06/2015–12/2021) were analyzed. NIHSS at admission, 24h and ENI definitions were compared for predicting excellent and good outcome, defined as modified Rankin Scale (mRS) 0-1 and 0-2. Factors impairing predictive power were identified based on multivariable logistic regression. Among 1,268 patients, 24h NIHSS showed the highest predictive accuracy, with an area under the curve (AUC) of 0.85 [95% Confidence Interval: 0.83-0.87] for both good and excellent outcomes. Optimal NIHSS thresholds were ≤8 for good and ≤7 for excellent outcomes. Advanced age, higher pre-stroke mRS, diabetes, and higher procedure passes significantly reduced prognostic accuracy. NIHSS at 24h, with thresholds of ≤8 and ≤7, is the best surrogate for predicting good and excellent functional outcomes in MCA-M2 occlusion patients. Prognostic value diminishes with advanced age, pre-stroke disability, and comorbidities such as diabetes.
Article Details
Authors (41)
Helge C. Kniep
Lukas Meyer
Gabriel Broocks
Matthias Bechstein
Christian Heitkamp
Laurens Winkelmeier
Tobias Faizy
Ludger Feyen
Caspar Brekenfeld
Uta Hanning
Susanne Gellißen
Arno Reich
Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany
Omid Nikoubashman
Christian Nolte
Eberhard Siebert
Charité–Universitätsmedizin Berlin, Berlin
Alexander Nave
Charlotte Pietrock
Gabor Petzold
Franziska Dorn
Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
Jan Hendrik Schäfer
Fee Keil
Institution of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
Anna Alegiani
Joachim Röther
Bernd Eckert
Maximilian Schell
Götz Thomalla
Fabian Flottmann
Jens Fiehler
Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Mario Abruscato
Sven Thonke
Timo Uphaus
Klaus Gröschel
Peter Schellinger
Jan Borggrefe
Lars Kellert
Hanna Zimmermann
Steffen Tiedt
Silke Wunderlich
Department of Neurology, Technical University of Munich, School of Medicine and Health, Klinikum Rechts der Isar, Munich, Germany
Tobias Boeckh-Behrens
Annerose Mengel
Ulrike Ernemann