Twenty-four-hour National Institute of Health Stroke Scale predicts short- and long-term outcomes of basilar artery occlusion after endovascular treatment

Jing Chen; Shuai Liu; Mingchao Wu; Ling Dai; Jie Wang; Weihua Xie; Yuqi Peng; Jinlin Mu; Shunyu Yang; Jinbo Ran; Jian Zhang; Wenshu Niu; Jingbang Zheng; Junxiong Wu; Guangxiong Yuan

doi:10.3389/fnagi.2022.941034

Twenty-four-hour National Institute of Health Stroke Scale predicts short- and long-term outcomes of basilar artery occlusion after endovascular treatment

Front Aging Neurosci. 2022 Oct 20:14:941034. doi: 10.3389/fnagi.2022.941034. eCollection 2022.

Authors

Jing Chen¹, Shuai Liu², Mingchao Wu³, Ling Dai⁴, Jie Wang⁵, Weihua Xie⁶, Yuqi Peng⁷, Jinlin Mu⁸, Shunyu Yang⁹, Jinbo Ran¹⁰, Jian Zhang¹¹, Wenshu Niu¹², Jingbang Zheng¹³, Junxiong Wu¹⁴, Guangxiong Yuan¹⁴

Affiliations

¹ Department of Neurology, Baoji Central Hospital, Baoji, Shanxi, China.
² Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
³ Department of Neurology, Jingdezhen No.1 People's Hospital, Jingdezhen, Jiangxi, China.
⁴ Department of Neurology, Luxian People's Hospital, Luzhou, Sichuan, China.
⁵ Department of Neurology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China.
⁶ Department of Neurology, People's Hospital of Mengzi, Mengzi, Yunnan, China.
⁷ Center of Brain, Sichuan Science City Hospital, Mianyang, China.
⁸ Department of Neurology, Traditional Chinese Medicine Hospital of Nanjiang, Bazhong, Sichuan, China.
⁹ Department of Neurology, The First People's Hospital of Yunnan, Kunming, Yunnan, China.
¹⁰ Department of Neurology, People's Hospital of Dejiang, Tongren, Guizhou, China.
¹¹ Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
¹² Department of Neurology, The 988th Hospital of the People's Liberation Army, Zhengzhou, Henan, China.
¹³ Department of Neurology, Chongqing Sanbo Changan Hospital, Chongqing, China.
¹⁴ Department of Emergency, Xiangtan Central Hospital, Xiangtan, Hunan, China.

Abstract

Background: The present study aimed to evaluate the prognostic value of the 24-h National Institute of Health Stroke Scale (NIHSS) for short- and long-term outcomes of patients with basilar artery occlusion (BAO) after endovascular treatment (EVT) in daily clinical routine.

Methods: Patients with EVT for acute basilar artery occlusion study registry with the 24-h NIHSS, and clinical outcomes documented at 90 days and 1 year were included. The NIHSS admission, 24-h NIHSS, NIHSS delta, and NIHSS percentage change, binary definitions of early neurological improvement [ENI; improvement of 4/(common ENI)/8 (major ENI)/10 (dramatic ENI)] NIHSS points were compared to predict the favorable outcomes and mortality at 90 days and 1 year. The primary outcome was defined as favorable if the modified Rankin Scale (mRS) score was 0-3 at 90 days.

Results: Of the 644 patients treated with EVT, the 24-h NIHSS had the highest discriminative ability for favorable outcome prediction [receiver operator characteristic (ROC)_{NIHSS 24 h} area under the curve (AUC): 0.92 (0.90-0.94)] at 90 days and 1 year [(ROC_{NIHSS 24 h} AUC: 0.91 (0.89-0.94)] in comparison to the NIHSS score at admission [ROC_{NIHSS admission} AUC at 90 days: 0.73 (0.69-0.77); 1 year: 0.74 (0.70-0.78)], NIHSS delta [ROC_{Δ NIHSS} AUC at 90 days: 0.84 (0.81-0.87); 1 year: 0.81 (0.77-0.84)], and NIHSS percentage change [ROC_%change AUC at 90 days: 0.85 (0.82-0.89); 1 year: 0.82 (0.78-0.86)].

Conclusion: The 24-h NIHSS with a threshold of ≤23 points was the best surrogate for short- and long-term outcomes after EVT for BAO in the clinical routine.

Keywords: National Institute of Health Stroke Scale (NIHSS); basilar; endovascular treatment; outcome; stroke.