Identifying the predictors of ultra early neurological improvement and its role in functional outcome after endovascular thrombectomy in acute ischemic stroke
Background and purposeUsing post-treatment methods to predict functional outcomes of acute ischemic stroke (AIS) patients undergoing endovascular thrombectomy (EVT) is crucial in stroke medicine. The National Institute of Health Stroke Scale (NIHSS) score at 24 h has been widely used; however, there...
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Frontiers Media S.A.
2025-01-01
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| author | Yuzheng Lai Mohammad Mofatteh José Fidel Baizabal-Carvallo José Fidel Baizabal-Carvallo Jianfeng He Wenhao Wu Daohong Wang Wenshan Yan Jicai Ma Sijie Zhou Yu Sun Yu Sun Yi He Shumei Li Hao Sun |
| author_facet | Yuzheng Lai Mohammad Mofatteh José Fidel Baizabal-Carvallo José Fidel Baizabal-Carvallo Jianfeng He Wenhao Wu Daohong Wang Wenshan Yan Jicai Ma Sijie Zhou Yu Sun Yu Sun Yi He Shumei Li Hao Sun |
| author_sort | Yuzheng Lai |
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| description | Background and purposeUsing post-treatment methods to predict functional outcomes of acute ischemic stroke (AIS) patients undergoing endovascular thrombectomy (EVT) is crucial in stroke medicine. The National Institute of Health Stroke Scale (NIHSS) score at 24 h has been widely used; however, there is a paucity of data on using earlier NIHSS scores and their association with outcome. In this study, we aimed to investigate the usage of NIHSS at 1-h time window -ultra-early neurological improvement (UENI)- as a surrogate marker associated with the functional outcomes of AIS patients treated with EVT.MethodsWe included 485 adults (≥18 years old) who underwent emergency EVT at four academic comprehensive stroke centers between 2020 and 2021. Patients with pre-EVT Alberta Stroke Program Early CT Score (ASPECTS) < 6, missing follow-up data, and missing data of the first hour NIHSS were excluded (n = 20). UENI was defined as post-EVT NIHSS reduction of 4 points or more or NIHSS as 0–1 within 1-h post-EVT. An mRS score of 0–2 after three months was defined as favorable outcome, and independent walking independence was defined as mRS of 3.ResultsA total of 465 patients were included in our final analysis. We identified 122 (26.2%) patients with UENI. While 82.79% of the patients with UENI achieved favorable functional outcomes at 3-months, only 32.36% of patients without UENI had favorable functional outcome (p < 0.0001). In addition, lower hospitalization costs were associated with patients who had UENI, compared to No-UENI (p = 0.003). A multivariate logistic regression analysis revealed that younger age (p < 0.0001), shorter last know normal to puncture time (LKNPT) (p = 0.013), higher pre-treatment ASPECTS (p = 0.039), final modified thrombolysis in cerebral infarction (mTICI) ≥2b (p = 0.002), and fewer number of EVT attempts (p = 0.002) were variables independently associated with UENI. The presence of UENI was independently associated with a better outcome OR: 7.999 (95% C.I. 4.415–14.495).ConclusionUENI was observed in about a quarter of patients with AIS undergoing EVT. Younger age, shorter LKNPT, higher pre-treatment ASPECTS, final mTICI≥2b, and fewer number of EVT attempts, were independently associated with UENI. The presence of UENI was independently associated with better functional outcome at 3 months. |
| format | Article |
| id | doaj-art-f0eecae21e294217b05fa6d6eae84548 |
| institution | Kabale University |
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| language | English |
| publishDate | 2025-01-01 |
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| spelling | doaj-art-f0eecae21e294217b05fa6d6eae845482025-01-31T06:39:59ZengFrontiers Media S.A.Frontiers in Neurology1664-22952025-01-011610.3389/fneur.2025.14920131492013Identifying the predictors of ultra early neurological improvement and its role in functional outcome after endovascular thrombectomy in acute ischemic strokeYuzheng Lai0Mohammad Mofatteh1José Fidel Baizabal-Carvallo2José Fidel Baizabal-Carvallo3Jianfeng He4Wenhao Wu5Daohong Wang6Wenshan Yan7Jicai Ma8Sijie Zhou9Yu Sun10Yu Sun11Yi He12Shumei Li13Hao Sun14Department of Neurology, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine (Nanhai District Hospital of Traditional Chinese Medicine of Foshan City), Foshan, ChinaSchool of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United KingdomParkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, United StatesDepartment of Sciences and Engineering, University of Guanajuato, León, MexicoDepartment of Neurology, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine (Nanhai District Hospital of Traditional Chinese Medicine of Foshan City), Foshan, ChinaThe Second Clinical Medical College, Guangdong Medical University, Zhanjiang, ChinaDepartment of Neurology, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine (Nanhai District Hospital of Traditional Chinese Medicine of Foshan City), Foshan, ChinaDepartment of Neurology, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine (Nanhai District Hospital of Traditional Chinese Medicine of Foshan City), Foshan, ChinaDepartment of Neurology, The Affiliated Yuebei People’s Hospital of Shantou University Medical College, Shaoguan, ChinaDepartment of Surgery of Cerebrovascular Diseases, First People's Hospital of Foshan, Foshan, ChinaDepartment of Neurology, Xiapu County Hospital, Ningde, ChinaDepartment of Neurology and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, ChinaDepartment of Neurology, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine (Nanhai District Hospital of Traditional Chinese Medicine of Foshan City), Foshan, China0Intervention Center, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine (Nanhai District Hospital of Traditional Chinese Medicine of Foshan City), Foshan, ChinaDepartment of Neurology, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine (Nanhai District Hospital of Traditional Chinese Medicine of Foshan City), Foshan, ChinaBackground and purposeUsing post-treatment methods to predict functional outcomes of acute ischemic stroke (AIS) patients undergoing endovascular thrombectomy (EVT) is crucial in stroke medicine. The National Institute of Health Stroke Scale (NIHSS) score at 24 h has been widely used; however, there is a paucity of data on using earlier NIHSS scores and their association with outcome. In this study, we aimed to investigate the usage of NIHSS at 1-h time window -ultra-early neurological improvement (UENI)- as a surrogate marker associated with the functional outcomes of AIS patients treated with EVT.MethodsWe included 485 adults (≥18 years old) who underwent emergency EVT at four academic comprehensive stroke centers between 2020 and 2021. Patients with pre-EVT Alberta Stroke Program Early CT Score (ASPECTS) < 6, missing follow-up data, and missing data of the first hour NIHSS were excluded (n = 20). UENI was defined as post-EVT NIHSS reduction of 4 points or more or NIHSS as 0–1 within 1-h post-EVT. An mRS score of 0–2 after three months was defined as favorable outcome, and independent walking independence was defined as mRS of 3.ResultsA total of 465 patients were included in our final analysis. We identified 122 (26.2%) patients with UENI. While 82.79% of the patients with UENI achieved favorable functional outcomes at 3-months, only 32.36% of patients without UENI had favorable functional outcome (p < 0.0001). In addition, lower hospitalization costs were associated with patients who had UENI, compared to No-UENI (p = 0.003). A multivariate logistic regression analysis revealed that younger age (p < 0.0001), shorter last know normal to puncture time (LKNPT) (p = 0.013), higher pre-treatment ASPECTS (p = 0.039), final modified thrombolysis in cerebral infarction (mTICI) ≥2b (p = 0.002), and fewer number of EVT attempts (p = 0.002) were variables independently associated with UENI. The presence of UENI was independently associated with a better outcome OR: 7.999 (95% C.I. 4.415–14.495).ConclusionUENI was observed in about a quarter of patients with AIS undergoing EVT. Younger age, shorter LKNPT, higher pre-treatment ASPECTS, final mTICI≥2b, and fewer number of EVT attempts, were independently associated with UENI. The presence of UENI was independently associated with better functional outcome at 3 months.https://www.frontiersin.org/articles/10.3389/fneur.2025.1492013/fullendovascular therapythrombectomyacute ischemic strokeanterior circulationpatient outcomeneurological improvement |
| spellingShingle | Yuzheng Lai Mohammad Mofatteh José Fidel Baizabal-Carvallo José Fidel Baizabal-Carvallo Jianfeng He Wenhao Wu Daohong Wang Wenshan Yan Jicai Ma Sijie Zhou Yu Sun Yu Sun Yi He Shumei Li Hao Sun Identifying the predictors of ultra early neurological improvement and its role in functional outcome after endovascular thrombectomy in acute ischemic stroke Frontiers in Neurology endovascular therapy thrombectomy acute ischemic stroke anterior circulation patient outcome neurological improvement |
| title | Identifying the predictors of ultra early neurological improvement and its role in functional outcome after endovascular thrombectomy in acute ischemic stroke |
| title_full | Identifying the predictors of ultra early neurological improvement and its role in functional outcome after endovascular thrombectomy in acute ischemic stroke |
| title_fullStr | Identifying the predictors of ultra early neurological improvement and its role in functional outcome after endovascular thrombectomy in acute ischemic stroke |
| title_full_unstemmed | Identifying the predictors of ultra early neurological improvement and its role in functional outcome after endovascular thrombectomy in acute ischemic stroke |
| title_short | Identifying the predictors of ultra early neurological improvement and its role in functional outcome after endovascular thrombectomy in acute ischemic stroke |
| title_sort | identifying the predictors of ultra early neurological improvement and its role in functional outcome after endovascular thrombectomy in acute ischemic stroke |
| topic | endovascular therapy thrombectomy acute ischemic stroke anterior circulation patient outcome neurological improvement |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2025.1492013/full |
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