ArticleFrontiers in neurology2025
24-hour NIHSS may be a reliable surrogate for 90-day mRS after mechanical thrombectomy-a prospective study in anterior and posterior circulation infarctions.
Article in Frontiers in neurology, 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
Background and objective: The 24-h National Institutes of Health Stroke Scale (NIHSS) is a promising early surrogate for 90-day functional outcome after mechanical thrombectomy (MT). However, its predictive performance in posterior circulation infarctions (PCI) is not well established. In addition, whether this association is consistent across anterior (ACI) and PCI territories, and whether it follows a linear or non-linear pattern, remains unclear. Methods: This prospective cohort included patients from two centers (2015-2022). The primary outcome was a favorable 90-day functional outcome (The modified Rankin Scale [mRS] score ≤2). The primary analysis used multivariable logistic regression to evaluate the predictive value of the 24-h NIHSS, with results expressed as the area under the curve (AUC). Secondary analyses included testing for interaction between the 24-h NIHSS and infarct location (ACI vs. PCI) and modeling non-linear relationships using restricted cubic splines. Results: A total of 334 patients were included (ACI: 282 [84.4%], PCI: 52 [15.6%]). Median baseline and 24-h NIHSS were 16 (IQR: 11-19) and 14 (6-20), respectively. The 24-h NIHSS demonstrated the highest predictive accuracy (AUC: 0.849, 95% CI: 0.805-0.893) compared to other metrics. An optimal cutoff of ≤6 yielded a sensitivity of 94.9% and specificity of 65.8%. Critically, no significant interaction between infarct location and NIHSS metrics was found ( Conclusion: The 24-h NIHSS is a reliable early surrogate for 90-day functional recovery post-MT in both ACI and PCI, outperforming both baseline NIHSS and
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