Evidence map›Paper›PMID 34402916›Full record

ArticleClinical neuroradiology2022

NIHSS 24 h After Mechanical Thrombectomy Predicts 90-Day Functional Outcome.

Philipp Hendrix, Itay Melamed, Malie Collins, Noah Lieberman, Vaibhav Sharma, Oded Goren, Ramin Zand, Clemens M Schirmer, Christoph J Griessenauer

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Article in Clinical neuroradiology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers.

0numbers the graph read from it
0cells of the map it votes in
27citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

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3 · Its place in the literature

Who cites it

27 citing papers in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

9 authors.

Philipp HendrixDepartment of Neurosurgery, Geisinger, Danville, PA, USA.
Itay MelamedDepartment of Neurosurgery, Geisinger, Danville, PA, USA.
Malie CollinsGeisinger Commonwealth School of Medicine, Scranton, PA, USA.
Noah LiebermanGeisinger Commonwealth School of Medicine, Scranton, PA, USA.
Vaibhav SharmaGeisinger Commonwealth School of Medicine, Scranton, PA, USA.
Oded GorenDepartment of Neurosurgery, Geisinger, Danville, PA, USA.
Ramin ZandDepartment of Neurology, Geisinger, Danville, PA, USA.
Clemens M SchirmerDepartment of Neurosurgery, Geisinger, Danville, PA, USA.
Christoph J GriessenauerDepartment of Neurosurgery, Geisinger, Danville, PA, USA. christoph.griessenauer@gmail.com.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMechanical thrombectomy (MT) for large vessel occlusion (LVO) ischemic stroke is a safe and effective treatment modality. The National Institute of Health Stroke Scale (NIHSS) 24 h after MT (24 h-NIHSS) was shown to serve as the strongest surrogate for 90-day functional outcome. Here, we seek to externally validate 24 h-NIHSS as predictor for 90-day functional outcome and explore additional variables in this context.

methodsPatients treated for anterior LVO between February 2016 and August 2020 with premorbid mRS < 3 were included. Receiver operating characteristics were used to compare different NIHSS-related surrogates, such as baseline (B) NIHSS, 24 h-NIHSS, Δ‑NIHSS and percent (%) change NIHSS to predict favorable function outcome (mRS 0-2). Additional analysis was performed to assess predictors associated with poor outcome despite reaching the best predictor threshold.

resultsA total of 337 eligible cases were identified. The 24 h-NIHSS outperformed B‑NIHSS, Δ‑NIHSS, and %‑NIHSS in terms of 90-day mRS 0-2 prediction. A 24-NIHSS ≤ 8 was identified as the optimal binary threshold. Multivariable analysis demonstrated that 24-NIHSS ≤ 8 and younger patient age were independently associated with mRS 0-2. Despite achieving 24 h-NIHSS ≤ 8, 23/143 (16.1%) cases experienced poor outcome (mRS 4-6). Older age, higher baseline NIHSS, coexisting chronic kidney disease, and longer hospital stay were independent predictors for poor outcome despite achieving 24 h-NIHSS ≤ 8.

conclusionAn NIHSS of 8 or less 24 h after MT was validated to serve as an independent, strong surrogate for favorable functional outcome; however, cofactors such as older age, higher baseline NIHSS and coexisting comorbidities appear to mitigate this clinical adjunct.

Indexed as

Arterial Occlusive DiseasesBrain IschemiaStrokeHumansRetrospective StudiesThrombectomyTreatment OutcomeIschemiaLarge vessel occlusionMechanical thrombectomyPredictorsStroke

Identifiers

PMID34402916

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