7-Day National Institutes of Health Stroke Scale as a surrogate marker predicting ischemic stroke patients' outcome following endovascular therapy

Background - Early neurological deterioration after endovascular thrombectomy (EVT) is associated with poor prognosis. National Institutes of Health Stroke Scale (NIHSS) score measured at 24 h after EVT may be a better outcome predictor than other methods that focus on changes in NIHSS. Nevertheless, clinical fluctuations in ischemic stroke patients during the immediate phase after symptoms onset are well recognized. Therefore, a delayed NIHSS evaluation may improve prognostic accuracy. We evaluate the 7-day NIHSS in predicting long-term patient outcomes after EVT.Methods - This was a multi-center retrospective cohort study of 300 consecutive ischemic stroke patients with large vessel occlusion who underwent EVT at three-stroke centers in China from August 2018 to March 2022. NIHSS was recorded on admission, pre-EVT, 24 h, and 7 days after EVT.Results - A total of 236 eligible patients were subdivided into two groups: 7-day NIHSS <= 6 and NIHSS >6 post-EVT. 88.29% achieved a favorable outcome (modified Rankin Scale 0-2) in the NIHSS <= 6 group compared to 15.20% in the NIHSS >6 group at 90 days, and an improved favorable outcome in the former group was observed after adjusting for potential confounding factors (adjusted odds ratio 39.7, 95% confidence interval, 17.5-89.7, p < 0.001).Conclusion - The 7-day NIHSS score may be a reliable predictor of 90-day stroke patient outcome after EVT.

Automated summary

The 7-day NIHSS score after EVT may serve as a reliable predictor of long-term outcomes in stroke patients. Patients who had an NIHSS score of 6 or lower at 7 days post-EVT had a higher proportion of favorable outcomes at 90 days. This finding provides a valuable tool for predicting the prognosis of stroke patients.