The National Institutes of Health Stroke Scale (NIHSS) at 24h is a strong predictor of long-term independence after mechanical thrombectomy for anterior circulation strokes. Its predictive value in patients with M2 segment of the middle cerebral artery (MCA-M2) occlusions, however, remains unclear. This study compares NIHSS scores at admission and 24h and early neurological improvement (ENI) definitions to predict functional outcomes at 90d for M2 occlusions. Patients with isolated MCA-M2 occlusions from the German Stroke Registry (06/2015–12/2021) were analyzed. NIHSS at admission, 24h and ENI definitions were compared for predicting excellent and good outcome, defined as modified Rankin Scale (mRS) 0-1 and 0-2. Factors impairing predictive power were identified based on multivariable logistic regression. Among 1,268 patients, 24h NIHSS showed the highest predictive accuracy, with an area under the curve (AUC) of 0.85 95% Confidence Interval: 0.83-0.87 for both good and excellent outcomes. Optimal NIHSS thresholds were ≤8 for good and ≤7 for excellent outcomes. Advanced age, higher pre-stroke mRS, diabetes, and higher procedure passes significantly reduced prognostic accuracy. NIHSS at 24h, with thresholds of ≤8 and ≤7, is the best surrogate for predicting good and excellent functional outcomes in MCA-M2 occlusion patients. Prognostic value diminishes with advanced age, pre-stroke disability, and comorbidities such as diabetes.
Kniep et al. (Tue,) studied this question.
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