National Institutes of Health Stroke Scale at 24 Hours is a Strong Predictor of Outcomes After Thrombectomy in Vertebrobasilar Occlusion.

Abstract

Background and objectives: The outcome predictors of mechanical thrombectomy (MT) for vertebrobasilar occlusion (VBO) are poorly defined. We aimed to investigate whether the National Institutes of Health Stroke Scale (NIHSS) score at 24 hours after MT for VBO can predict patient outcomes.

Methods: Patients with basilar artery occlusion (including VBO) from January 2014 to December 2023 were retrospectively enrolled. Receiver operating characteristic curves identified the NIHSS cutoff values at 24 h for predicting modified Rankin Scale (mRS) scores of 0-3 and 90-day mortality; logistic regression validated these cutoff values.

Results: From the MT registry, 164 patients met the inclusion criteria (mean age, 67 ± 15 years; 91 [55.5%] male). The mean NIHSS score at admission was 18 ± 9 points; the time from last known well to arrival was 9.0 ± 6.1 h. A modified Thrombolysis in Cerebral Infarction score ≥2b was achieved in 147 patients (89.6%). The mean NIHSS score at 24 h was 13 ± 9 points, and 73 patients (44.5%) had a mRS score of 0-3 at 90 days. The NIHSS score cutoff value for predicting a 90-day mRS score of 0-3 was ≤10 points at 24 h (area under the curve: 0.86); among patients meeting these criteria, 85% achieved a 90-day mRS score of 0-3. The cutoff value for predicting 90-day mortality was an NIHSS score of ≥15 points at 24 hours, with an area under the curve of 0.81; among patients meeting these criteria, 81% died within 90 days.

Conclusion: The NIHSS score at 24 hours can predict outcomes in patients with VBO after thrombectomy.