NIHSS Consciousness Score Combined with ASPECTS is a Favorable Predictor of Functional Outcome post Endovascular Recanalization in Stroke Patients

Abstract

Although revascularization rates after endovascular thrombectomy for large vessel acute ischemic stroke (AIS) are high (71%), only 46% of patients achieve functional independence at 90 days. The present study was designed to explore a new method for predicting the functional prognosis of AIS patients after endovascular recanalization. A total of 200 anterior circulation stroke patients who received endovascular therapy were enrolled. Logistic regression analysis of clinical characteristics on functional independence were performed. The predictive power of sub-items in National Institute of Health stroke scale (NIHSS) and the combination of NIHSS consciousness and Alberta Stroke Program Early CT Score (ASPECTS) on functional independence were assessed by Receiver Operating Characteristic (ROC) curves and the latter was compared with 3 previously published prediction models by AUC (the area under ROC curve). The AUC for the NIHSS consciousness score to predict functional independence was higher than whole NIHSS and other sub-items (0.716 v 0.705, 0.586, 0.573, 0.552 and 0.559). Low NIHSS consciousness score, high ASPECTS score, short time from onset to recanalization, and high rate of successful recanalization were demonstrated to be significantly associated with the functional independence (OR 0.697, 2.226, 0.994 and 28.643). The prediction power of the combination was significantly better than NIHSS and ASPECTS alone (AUC 0.793 v 0.705 and 0.752). Compared with 3 other prediction models, the combination was found to be the strongest predictor for functional independence (AUC 0.793 v 0.791, 0.671 and 0.564). NIHSS which has been shown to be a strong predictor of functional outcomes after endovascular recanalization is largely dependent on the consciousness component. NIHSS consciousness score combined with ASPECTS appears to be a favorable predictor of functional independence. These findings may have broad reaching effects for isolated centers around the world without advanced imaging for triage and prognostication.

Association of Lesion Topography with Functional Outcomes in Acute Ischemic Stroke Patients Considered for, or Receiving, Reperfusion Therapy: A Meta-Analysis

“…Our meta-analysis revealed a clear association of decreasing ASPECTS with odds of poor functional outcomes regardless of the RT received. This is in line with the previous studies that found that decreased ASPECTS are associated with worse functional outcomes [ 16 , 19 , 22 , 33 , 35 , 38 ]. Despite the study design and cohort size, most of the included studies in this meta-analysis found a significant relationship between poor functional outcomes and ASPECTS cut-off points of 6 [ 27 , 30 , 36 , 37 , 38 ], 7 [ 24 , 25 , 26 , 34 , 38 ] and 8 [ 6 , 23 , 29 , 31 , 38 ].…”

“…The 6 studies, comprising 735 patients, included in the meta-analysis demonstrated that there was a significant association of increasing ASPECTS with poor functional outcomes at 90 days (SMD = −1.15; 95% CI −1.77–−0.52; p < 0.0001) ( Figure 3 ) [ 16 , 19 , 22 , 33 , 35 , 38 ]. Moderate to considerable heterogeneity was found between the studies (I 2 = 93.1%, p < 0.0001).…”

The Hemoglobin, Albumin, Lymphocytes and Platelets (HALP) Predicts Long-term Survival in Posterior Circulation Ischemic Stroke

“…The association is easy to understand because NIHSS is the most commonly used scale to evaluate the neurologic de cit in stroke patients. Numerous studies have also con rmed the predictive effect of NIHSS on prognosis of PCIS and basilar artery occlusion patients [26][27][28][29] . In the present study, besides the NIHSS score, we also examined the predictive value of pc-ASPECTS, which has been widely studied in PCIS patients.…”

Role of Rph3A in brain injury induced by experimental cerebral ischemia‐reperfusion model in rats

“…3 Unfortunately, effective treatment strategies for ischemic stroke are limited, and include intravenous thrombolysis and mechanical thrombectomy that aim to restore the blood supply to the affected brain region. 4 However, there is a potential risk of recanalization, that is, reperfusion injury, manifested by increased cerebral edema, infarct progression, hemorrhagic stroke, and neurological deterioration. 5 Previous studies have suggested that these changes may be associated with excitotoxicity, neuroinflammation, oxidative stress, calcium overload, autophagy, and apoptosis.…”

“…Many patients were discharged with varying degrees of sequelae that seriously affect the quality of life 3 . Unfortunately, effective treatment strategies for ischemic stroke are limited, and include intravenous thrombolysis and mechanical thrombectomy that aim to restore the blood supply to the affected brain region 4 . However, there is a potential risk of recanalization, that is, reperfusion injury, manifested by increased cerebral edema, infarct progression, hemorrhagic stroke, and neurological deterioration 5 .…”