What fucking stupidity! All you are doing
is predicting failure to recover! Survivors want recovery. Create
protocols that will do that! Useless.
Predictors of failure of early neurological improvement in early time window following endovascular thrombectomy: a multi-center study
Yuzheng Lai1 
Francesco Diana2 
Mohammad Mofatteh3 
Thanh N. Nguyen4 Eric Jou5 Sijie Zhou6 Hao Sun1 Jianfeng He1 Wenshan Yan1 Yiying Chen1 Mingzhu Feng7 Junbin Chen8 Jicai Ma8 Xinyuan Li9 Heng Meng10* 
Mohamad Abdalkader4* 
Yimin Chen7,11*- 1Department of Neurology, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine (Nanhai District Hospital of Traditional Chinese Medicine of Foshan City), Foshan, China
- 2Department of Neuroradiology, A.O.U. San Giovanni di Dio e Ruggi d’Aragona, University of Salerno, Salerno, Italy
- 3School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
- 4Department of Radiology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
- 5School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- 6Department of Surgery of Cerebrovascular Diseases, First People’s Hospital of Foshan, Foshan, China
- 7Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People’s Hospital, Foshan, China
- 8Department of Neurology, The Affiliated Yuebei People’s Hospital of Shantou University Medical College, Shaoguan, China
- 9The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- 10Department of Neurology, The First Affiliated Hospital of Jinan University, Clinical Neuroscience Institute of Jinan University, Guangzhou, China
- 11Neuro International Collaboration (NIC), Foshan, China
Background and objective: Endovascular thrombectomy (EVT) has become the gold standard in the treatment of acute stroke patients. However, not all patients respond well to this treatment despite successful attempts. In this study, we aimed to identify variables associated with the failure of improvements following EVT.
Methods: We retrospectively analyzed prospectively collected data of 292 ischemic stroke patients with large vessel occlusion who underwent EVT at three academic stroke centers in China from January 2019 to February 2022. All patients were above 18 years old and had symptoms onset ≤6 h. A decrease of more than 4 points on the National Institute of Health Stroke Scale (NIHSS) after 24 h compared with admission or an NIHSS of 0 or 1 after 24 h was defined as early neurological improvement (ENI), whereas a lack of such improvement in the NIHSS was defined as a failure of early neurological improvement (FENI). A favorable outcome was defined as a modified Rankin scale (mRS) score of 0–2 after 90 days.
Results: A total of 183 patients were included in the final analyses, 126 of whom had FENI, while 57 had ENI. Favorable outcomes occurred in 80.7% of patients in the ENI group, in contrast to only 22.2% in the FENI group (p < 0.001). Mortality was 7.0% in the ENI group in comparison to 42.1% in the FENI group (p < 0.001). The multiple logistic regression model showed that diabetes mellitus [OR (95% CI), 2.985 (1.070–8.324), p = 0.037], pre-stroke mRS [OR (95% CI), 6.221 (1.421–27.248), p = 0.015], last known well to puncture time [OR (95% CI), 1.010 (1.003–1.016), p = 0.002], modified thrombolysis in cerebral infarction = 3 [OR (95% CI), 0.291 (0.122–0.692), p = 0.005], and number of mechanical thrombectomy passes [OR (95% CI), 1.582 (1.087–2.302), p = 0.017] were the predictors of FENI.
Conclusion: Diabetes mellitus history, pre-stroke mRS, longer last known well-to-puncture time, lack of modified thrombolysis in cerebral infarction = 3, and the number of mechanical thrombectomy passes are the predictors of FENI. Future large-scale studies are required to validate these findings.
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