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Relative versus absolute early neurological improvement after mechanical thrombectomy for large vessel occlusion stroke – hot or not?
  1. Philipp Hendrix,
  2. Clemens M Schirmer
  1. Geisinger Health System, Wilkes-Barre, Pennsylvania, USA
  1. Correspondence to Dr Philipp Hendrix, Geisinger Health System, Wilkes-Barre, Pennsylvania, USA; hendrix.philipp{at}gmail.com

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Early clinical surrogates for long-term functional outcomes represent valuable clinical adjuncts. Lately, the National Institutes of Health Stroke Scale (NIHSS) score 24 hours after mechanical thrombectomy (MT) for large vessel occlusion (LVO) ischemic stroke has been repeatedly demonstrated to serve as a robust and independent predictor of 90-day functional outcomes.1–5

We read the article ‘Early neurological improvement as a predictor of outcomes after endovascular thrombectomy for stroke: a systematic review and meta-analysis’ by Kobeissi et al with great interest.6 Briefly, the authors synthesized nine studies with different definitions of early neurological improvement (ENI), such as relative improvement of NIHSS. They observed ENI be strongly associated with good functional outcomes and inversely with mortality and symptomatic intracranial hemorrhage.

We want to point out several aspects that deserve further attention. First, the authors contend that having incorporated various definitions of ENI, such as improvement of NIHSS ≥8, NIHSS ≥4, 12%, and ≥30%, would demonstrate that, broadly, ENI represents a promising predictor of 90-day function outcomes. However, in our opinion, synthesizing nine studies with numerous different criteria merely represents how meta-analysis may oversimplify variables …

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Footnotes

  • Contributors PH: conception and design of the work, data collection, and interpretation, drafting of the article, final approval of the version to be published. CS: data interpretation and critical revision of the article, final approval of the version to be published.

  • 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 None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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