Muhammad Taimoor Khan, MD
Rudilosso S, Urra X, Amaro S, Llull L, Renú A, Laredo C, et al. Timing and Relevance of Clinical Improvement After Mechanical Thrombectomy in Patients With Acute Ischemic Stroke. Stroke. 2019;50:1467–1472
Mechanical thrombectomy can prevent functional dependence in about half of the patients with acute ischemic stroke from proximal vessel occlusion. Dr. Rudilosso and his colleagues studied the relevance of the timing of clinical improvement in the prediction of long-term outcome in patients treated with mechanical thrombectomy. Patients who presented substantial clinical improvement SCI at the earliest assessment after MT had the highest odds for functional recovery at 3 months and an improvement >30% in National Institutes of Health Stroke Scale score NIHSS at the end of MT represents a reliable prognostic marker.
They found 334 patients (79.0%) in cohort of 423 patients treated with MT achieved good outcome (modified Rankin Scale score of 0-2 at 90-day follow-up). NIHSS scores were assessed before MT, at the end of MT (d0), at day 1 (d1), and at day 7 or discharge (d7). They measured the absolute difference and percentage changes of NIHSS scores overtime in comparison before thrombectomy. They classified patients in SCI subgroups according to the delay from MT to SCI (SCI-d0, SCI-d1, and SCI-d7). The most independent factor predicting SCI-d0 was successful reperfusion. They also found that age and glucose levels were not related with delay in SCI.
This study provides a good foundation for future studies to look for factors that will predict early clinical improvement after mechanical thrombectomy. SCI substantial clinical improvement along with grade of reperfusion after MT mechanical thrombectomy can find implications in clinical research as well.