Nomogram predicting early neurological improvement in ischaemic stroke patients treated with endovascular thrombectomy

Abstract

Background and purpose: Early neurological improvement (ENI) after endovascular thrombectomy (EVT) has been associated with favorable outcomes. This study aimed to identify the optimal definition of ENI and develop a nomogram for predicting ENI after EVT in acute ischaemic stroke. Methods: Patients with EVT were enrolled from a multicenter registry as the training cohort. The receiver operating characteristic curve was used to estimate the optimal threshold for ENI at 24 h of EVT. Logistic regression analysis was utilized to generate the best-fit nomogram for predicting ENI. The discrimination of the nomogram was assessed using the area under the receiver operating characteristic curve (AUC). An additional 447 patients from two stroke centers were prospectively recruited as the test cohort for validating the nomogram. Results: A total of 612 patients with EVT were included in the training cohort. The optimal threshold for predicting 3-month favorable outcome (modified Rankin Scale 0-2) was an improvement of the National Institutes of Health Stroke Scale (NIHSS) score by ≥6 points (AUC 0.875; sensitivity 79.5%; specificity 90.7%). Age, blood glucose, recanalization, symptomatic intracranial hemorrhage (sICH) and baseline Alberta Stroke Program Early Computed Tomography Score (ASPECTS) were independently associated with ENI, and were incorporated in the nomogram. The AUC of the nomogram was 0.795 in the training cohort and 0.752 in the test cohort. Conclusions: A reduction of NIHSS score ≥6 appeared to be the optimal definition of ENI. The nomogram composed of age, blood glucose, recanalization, sICH and baseline ASPECTS may predict the probability of ENI in ischaemic stroke patients treated with EVT.

Endothelial caveolin-1 regulates cerebral thrombo-inflammation in acute ischemia/reperfusion injury

“…ENI was defined as a reduction of total NIHSS score within 24 h after EVT ≥ 6 points compared with the initial NIHSS. 41 …”

Levels of adhesion molecules and clinical outcomes in patients with ischemic stroke after mechanical thrombectomy

“…The collateral circulation extent was assessed by the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology grading system ( 22 ), and divided into poor (grades 0–1) or good (grades 2–4). The successful reperfusion was defined as a modified Thrombolysis in Cerebral Infarction score of 2b−3 ( 4 , 6 ).…”

“…Patients were followed up 90 days after stroke onset at the outpatient stroke clinic or via telephone by neurologists who were blind to the clinical data. Poor outcome was defined as an mRS score of 3–6 ( 5 , 6 ).…”

Younger adults and endovascular thrombectomy

“…Firstly, many variables in patients who have undergone endovascular thrombectomy, such as fasting blood glucose, triglycerides, body mass index, and medical history may be outcome-related [2,3]. Moreover, it might have been possible for the authors to collect data on collateral circulation score according to digital subtraction angiography and not only by CT angiogram.…”