ArticleScientific reports2025
NIHSS mismatch as a predictor of early neurological improvement after mechanical thrombectomy.
Article in Scientific reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
The selection of acute ischemic stroke (AIS) patients for mechanical thrombectomy (MT) is based on the clinical-radiological mismatch, where the NIHSS is higher than expected based on the ASPECT score. Our objective was to estimate the mismatch (NIHSSmismatch%) between the expected NIHSS (NIHSSexpected) and the actual NIHSS (NIHSSactual) on admission, and to study its prognostic value for early neurological improvement (ENI, defined as a reduction of NIHSS of ≥ 8 points or reaching 0/1 at 24 h) in AIS patients with large vessel occlusion (LVO) of the anterior circulation treated with MT. A cross-sectional study was conducted on AIS related to anterior territory LVO (2017–2022) at a Stroke Center. Using multivariate linear regression models in the derivation cohort, a formula for calculating the NIHSSexpected on admission was developed, and the NIHSSmismatch% between NIHSSactual and NIHSSexpected was measured. Multivariate analyses were performed to identify if NIHSSmismatch% levels predicted ENI. In the derivation cohort (n = 123), the following formula was developed: NIHSSexpected = 10.8 + 0.05 x Age + 2.5 x DM + 2.6 x Hemisphere – 1.5 x ASPECTSadmission. In the validation cohort (n = 185), 64 (34.6%) patients experienced ENI. The ROC curve identified 75% of NIHSSmismatch% as the optimal cutoff for predicting ENI (80% sensitivity and 58% specificity). Multivariate analyses showed that both NIHSSmismatch% and NIHSSmismatch% >75 were predictors of ENI (OR 1.062; 95% CI 1.033–1.092 and OR 5.687; 95% CI 2.562–12.623, respectively), adjusted for potential confounders. NIHSSmismatch% could be a predictor of ENI in AIS patients treated with MT.
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