Nomogram predicting early neurological improvement in ischemic stroke patients treated with endovascular thrombectomy.

Background Early neurological improvement (ENI) after endovascular thrombectomy (EVT) has been associated with favorable outcomes. This study aimed to identify the optimal definition of ENI, and develop a nomogram for predicting ENI after EVT in acute ischemic stroke. Methods Patients with EVT were enrolled from a multicenter registry as the training cohort. Receiver operating characteristic curve was used to estimate the optimal threshold for ENI at 24 hours of EVT. Logistic regression analysis was utilized to generate the best-fit nomogram for predicting ENI. The discrimination of the nomogram was assessed using area under the receiver operating characteristic curve (AUC). An additional 447 patients from 2 stroke centers were prospectively recruited as the test cohort for validating the nomogram. Results A total of 612 patients with EVT were included in training cohort. The optimal threshold for predicting 3-month favorable outcome (modified Rankin Scale 0-2) was an improvement of National Institutes of Health Stroke Scale score ≥ 6 points (AUC, 0.875; sensitivity, 79.5%; specificity, 90.7%). Age, blood glucose, recanalization, symptomatic intracranial hemorrhage (sICH) and baseline Alberta Stroke Program Early Computed Tomography Score (ASPECTS) were independently associated with ENI, and were incorporated in the nomogram. The AUC of the nomogram was 0.795 in training cohort, and 0.752 in test cohort. Conclusions A reduction of NIHSS score ≥ 6 appeared to be the optimal definition of ENI. The nomogram composed with age, blood glucose, recanalization, sICH and baseline ASPECTS may predict the probability of ENI in ischemic stroke patients treated with EVT.