Early Neurological Improvement Predicts Clinical Outcome after Acute Basilar Artery Stroke Thrombectomy

Background: Mechanical thrombectomy (MT) is standard-of-care for patients with anterior-circulation large vessel occlusion. An early neurological improvement (ENI), defined as a reduction of ≥8 on the National Institutes of Health Stroke-Scale (NIHSS) compared with baseline score, or an NIHSS of 0 or 1 at 24 hours after MT, is a strong predictor of 3-month favorable outcome in such patients. The impact of ENI after MT in stroke patients with a basilar artery occlusion (BAO) on 3-months outcome is not clear. We aimed to study the effects of ENI in BAO patients.

Materials and Methods: We performed a retrospective analysis of a multicenter prospective cohort of all consecutive stroke patients with BAO who underwent MT. We compared clinical outcomes between BAO patients stratified by ENI. Multivariate analyses were performed to determine the impact of ENI on favorable 90-day outcome (modified Rankin's scale of 0–3) and report factors contributing to ENI.

Results: A total of 237 patients were included. An ENI was seen in 70 (30%) patients. Outcomes were significantly better in ENI+ patients, with 84% achieving favorable outcome (mRS: 0–3) at 3 months versus 30% for ENI patients (p < 0.0001). In multivariate analysis, ENI was an independent predictive factor associated with higher rates of favorable outcome (odds ratio = 18.12 [3.95–83.10], p = 0.0001). A higher number of passes (odds ratio = 0.62 [0.43–0.89], p = 0.010) and need for stenting (odds ratio = 0.27 [0.07–0.95], p = 0.041) were negatively associated with ENI.

Conclusion: ENI at day 1 following MT for BAO is a strong independent predictor of a favorable 3-month clinical outcome.

Publikationsverlauf

Artikel online veröffentlicht:
14. Dezember 2021