Evaluation of Patients with High National Institutes of Health Stroke Scale as Thrombectomy Candidates Using the Kentucky Appalachian Stroke Registry

Abstract

Introduction: Mechanical thrombectomy has become standard of care for emergent large vessel occlusive stroke. Estimates of incidence for thrombectomy eligibility vary significantly. National Institutes of Health Stroke Scale (NIHSS) of 10 or greater is highly predictive of large vessel occlusion. Using our Kentucky Appalachian Stroke Registry (KApSR), we evaluated temporal trends in stroke admissions with NIHSS ≥10 to determine patient characteristics among that group along with effects and needs in thrombectomy utilization. Methods: Using the KApSR database that captures patients throughout the Appalachian region in our stroke network, we evaluated patients admitted with ischemic stroke with NIHSS ≥10. We recorded demographics, comorbidities, treatment (thrombectomy, decompressive craniectomy), and county of origin. Change in NIHSS from admission to discharge was used as an indicator of inpatient outcome. Results: Between 2010 and 2016, 1,510 patients were admitted with NIHSS ≥10. 87.2% had high blood pressure, 69.6% had dyslipidemia, and 41.7% used tobacco. There were significant sex differences in the types of patients presenting with NIHSS ≥10 with females being older on average and having more atrial fibrillation and obesity. There was an increase in thrombectomy utilization from 2010 to 2016, but only 7.5% of the potentially eligible patients underwent the procedure. In comparison to the period 2010–2014, the 2015–2016 period had higher rates of obesity and tobacco abuse. Conclusion: Among patients with significant burden of ischemic stroke, the most common coexisting medical condition was high blood pressure. Patients who underwent thrombectomy had significantly better inpatient clinical improvement. These data support the need to maximize utilization of thrombectomy along with need to devote increased resources on modifiable stroke risk factors.

A Meta-Analysis of Prognostic Factors in Patients with Posterior Circulation Stroke after Mechanical Thrombectomy

“…However, other studies revealed that compared to relative male patients with acute anterior circulation stroke, female patients exhibited poorer prognosis after recanalization [48]. Previous reports indicate that key factors, including gender differences in risk factors and types and proportions of ischemic stroke complications, lead to asymmetry in clinical outcomes between male and female patients [49]. Most male patients have a history of smoking and drinking and are prone to CAD.…”

“…Most male patients have a history of smoking and drinking and are prone to CAD. Female patients are exposed to other risk factors, including obesity, hypertension, atrial fibrillation, and venerable age [49, 50]. In addition, many factors that cannot be evaluated rapidly, such as weakness, musculoskeletal function, neurological dysfunction, and social psychological status before stroke, may also adversely affect prognosis in females [51, 52].…”

“…In addition, many factors that cannot be evaluated rapidly, such as weakness, musculoskeletal function, neurological dysfunction, and social psychological status before stroke, may also adversely affect prognosis in females [51,52]. Gender is associated with multiple cerebrovascular disease risk factors [49][50][51][52], which should be taken into account and managed effectively. Our meta-analysis showed that the prognosis of posterior circulation occlusion patients who received MT did not vary by gender.…”

Only a Minority of Thrombectomy Candidates Are Admitted During Night Shift: A Rationale for Diurnal Stroke Care Planning

“…An NIHSS ≥10 was identified as the most balanced threshold to predict LVO with a sensitivity of 73% and specificity of 74% ( 9 ). Thus, the NIHSS score is a frequently used prediction instrument for LVO ( 28 , 29 ).…”

“…An NIHSS ≥10 was identified as the most balanced threshold to predict LVO with a sensitivity of 73% and specificity of 74% (9). Thus, the NIHSS score is a frequently used prediction instrument for LVO (28,29). Secondly, ∼15.9% of the patients with AIS were excluded from the analysis because the NIHSS score at admission was missing.…”