Abstract W MP12: Sequential NIHSS Change is a Better Predictor of Good Functional Outcome than Pre-Treatment Neurological Status after Mechanical Thrombectomy in Acute Stroke
Purpose: Pre-treatment NIHSS has been shown to be the strongest predictor of outcome after endovascular therapy in acute ischemic stroke. However, it is not clear if sequential changes in NIHSS scores have any predictive value after mechanical thrombectomy cases.
Methods: Prospective (Pivotal N=119, PICS N=219, START N=124) and retrospective/registry (POST N=95, RetroSTART N=168) cases using the Penumbra System were pooled. All were IV tPA-ineligible or refractory with treatment at <8 h. The association of NIHSS pre- and post-treatment and good clinical outcome (mRS 0-2 at 90 days) was tested.
Results: Among 725 patients, mean age was 66 ± 15 and median admission NIHSS score was 17 (IQR 13-21). Median NIHSS improved to 11 at 7 days. NIHSS scores at 7 days showed a stronger relationship with good outcome (correlation 0.84; p<0.001) than baseline (correlation 0.37; p<0.001). Furthermore, serial NIHSS scores (baseline minus 7 day) also predicted good outcome (correlation -0.69; p<0.001). Age (correlation 0.39, p < 0.001), pre-treatment ASPECTS score (correlation -0.19; p < 0.001) but not reperfusion to TIMI 2-3/TICI 2b-3 also demonstrated associations with good outcome.
Conclusion: In this pooled Penumbra cohort, post treatment improvement in neurological status significantly predicted good clinical and functional outcomes, independent of reperfusion status.
Author Disclosures: J. Mocco: Ownership Interest; Modest; Medina Medical, Blockade Medical. Consultant/Advisory Board; Modest; Codman Neurovascular, Lazarus Effect, Pulsar Medical, Medina Medical. Research Grant; Significant; Stryker Neurovascular, NIH 1U01NS086492-01, NIH 1R01NS078828-01A1. Other Research Support; Significant; Stryker Neurovascular, Covidien. A.J. Yoo: Other Research Support; Modest; Dutch Heart Foundation. Research Grant; Significant; Penumbra Inc. O.O. Zaidat: Research Grant; Significant; Penumbra, Inc.. Ownership Interest; Significant; Galaxy Therapeutics. Consultant/Advisory Board; Modest; Stryker, Gore Medical. H. Buell: Employment; Significant; Penumbra, Inc. S.S. Kuo: Employment; Significant; Penumbra, Inc. A. Bose: Employment; Significant; Penumbra, Inc.. Ownership Interest; Significant; Penumbra, Inc. S. Sit: Employment; Significant; Penumbra, Inc.. Ownership Interest; Significant; Penumbra, Inc..
- © 2015 by American Heart Association, Inc.