The following is a summary of “Predicting Outcomes After Mechanical Thrombectomy: Early vs Delayed Neurological Improvement in the SELECT Database,” published in the November 2023 issue of Neurology by Duncan et al.

Researchers started a retrospective study to identify factors predicting whether ischemic stroke patients with large vessel occlusions who undergo mechanical thrombectomy experience early or delayed neurological improvement.

They analyzed patient data from the SELECT study, conducted at 9 US centers (1/2016 to 2/2018) and enrolled patients with acute ischemic stroke due to anterior circulation large vessel occlusion in a multicenter cohort study. Patients were split into mechanical thrombectomy or medical management; the analysis focused on 149 from the former. Early and late neurological improvement predictors were categorized into pre-procedure (e.g., age, baseline NIHSS) and post-procedure (e.g., 24-hour NIHSS, ASPECTS on follow-up imaging). Significant predictors of early and delayed improvement were identified using backward stepwise regression.

The results showed pre‐procedure predictors of early neurological improvement (mRS 0‐2 at discharge) included age (P=0.001), NIHSS score (P=0.002), ischemic core volume (P=0.001), transfer status (P=0.019), and successful reperfusion (mTICI 2b or better, P=0.001). A post‐procedure predictor of early neurological improvement was the NIHSS score at 24 hours (P<0.001). Pre‐procedure prediction of delayed neurological improvement (mRS 0‐2 at 90 days for those without early neurological improvement) involved ischemic core volume (P=0.003). Final infarct volume (P=0.012), change in ASPECTS on follow‐up imaging (P=0.001), and infarct size growth (P=0.030) predicted delayed neurological improvement. Age (P=0.001), NIHSS score (P<0.001), successful reperfusion (P=0.001), ischemic core volume (P=0.004), and infarct growth rate (P=0.034) were pre‐procedure predictors for early excellent outcome (mRS 0‐1 at discharge). The pre‐procedure predictor for delayed excellent outcome (mRS 0‐1 at 90 days without early excellent outcome) was NIHSS score (P=0.002). Also, a midline shift of 5mm or more at 24 hours correlated with poor outcome at 90 days.

They concluded that stroke thrombectomy patients with higher NIHSS scores and 24-hour midline shifts experienced greater delays in achieving good outcomes.

Source: ahajournals.org/doi/10.1161/SVIN.03.suppl_2.203