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Ischemic Stroke
Case series
Can early neurological improvement after mechanical thrombectomy be used as a surrogate for final stroke outcome?
  1. Sebastien Soize1,2,
  2. Guillaume Fabre1,
  3. Matthias Gawlitza1,
  4. Isabelle Serre3,
  5. Serge Bakchine3,
  6. Pierre-François Manceau1,
  7. Laurent Pierot1
  1. 1 Department of Neuroradiology, CHU Reims, Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
  2. 2 INSERM, UMR-S 1237 Physiopathology and imaging of Neurological disorders, Normandie University, UNICAEN, Cyceron, France
  3. 3 Department of Neurology, CHU Reims, Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
  1. Correspondence to Dr Laurent Pierot, Department of Radiology, University Hospital Reims, Reims, 51100, France; lpierot{at}gmail.com

Abstract

Background and purpose We aimed to identify the best definition of early neurological improvement (ENI) at 2 and 24 hours after mechanical thrombectomy (MT) and determine its ability to predict a good functional outcome at 3 months.

Methods This retrospective analysis was based on a prospectively collected registry of patients treated by MT for ischemic stroke from May 2010 to March 2017. We included patients treated with stent-retrievers with National Institute of Health Stroke Scale (NIHSS) score before treatment and at 2 and/or 24 hours after treatment and modified Rankin Score (mRS) at 3 months. Receiver operating characteristic curve analysis was performed to estimate optimal thresholds for ENI at 2 and 24 hours. The relationship between optimal ENI definitions and good outcome at 3 months (mRS 0–2) was assessed by logistic regression.

Results The analysis included 246 patients. At 2 hours, the optimal threshold to predict a good outcome at 3 months was improvementin the NIHSS score of >1 point (AUC 0.83,95% CI 0.77 to 0.87), with sensitivity and specificity 78.3% (62.2–85.7%) and 84.6% (77.2–90.3%), respectively, and OR 12.67 (95% CI 4.69 to 31.10, p<0.0001). At 24 hours, the optimal threshold was an improvementin the NIHSS score of >4 points (AUC 0.93, 95% CI 0.89 to 0.96), with sensitivity and specificity 93.8% (87.7–97.5%) and 83.2% (75.7–89.2%), respectively, and OR 391.32 (95% CI 44.43 to 3448.35, p<0.0001).

Conclusions ENI 24 hours after thrombectomy appears to be a straightforward surrogate of long-term endpoints and may have value in future research.

  • stroke
  • thrombectomy

https://doi.org/10.1136/neurintsurg-2018-014332

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    Footnotes

    • Contributors All authors have made a substantial contribution to the conception and design of the studies and/or the acquisition and/or the analysis of the data and/or the interpretation of the data; drafted the work or revised it for significant intellectual content; approved the final version of the manuscript; and agree to be accountable for all aspects of the work, including its accuracy and integrity.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests LP is consultant for Balt, Microvention, Neuravi, and Penumbra.

    • Patient consent Obtained.

    • Ethics approval Ethics approval was obtained from Reims Ethics Committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.