Early surrogates of functional outcome after thrombectomy for MCA-M2 occlusions

The National Institutes of Health Stroke Scale (NIHSS) at 24h is a strong predictor of long-term independence after mechanical thrombectomy for anterior circulation strokes. Its predictive value in patients with M2 segment of the middle cerebral artery (MCA-M2) occlusions, however, remains unclear. This study compares NIHSS scores at admission and 24h and early neurological improvement (ENI) definitions to predict functional outcomes at 90d for M2 occlusions. Patients with isolated MCA-M2 occlusions from the German Stroke Registry (06/2015–12/2021) were analyzed. NIHSS at admission, 24h and ENI definitions were compared for predicting excellent and good outcome, defined as modified Rankin Scale (mRS) 0-1 and 0-2. Factors impairing predictive power were identified based on multivariable logistic regression. Among 1,268 patients, 24h NIHSS showed the highest predictive accuracy, with an area under the curve (AUC) of 0.85 [95% Confidence Interval: 0.83-0.87] for both good and excellent outcomes. Optimal NIHSS thresholds were ≤8 for good and ≤7 for excellent outcomes. Advanced age, higher pre-stroke mRS, diabetes, and higher procedure passes significantly reduced prognostic accuracy. NIHSS at 24h, with thresholds of ≤8 and ≤7, is the best surrogate for predicting good and excellent functional outcomes in MCA-M2 occlusion patients. Prognostic value diminishes with advanced age, pre-stroke disability, and comorbidities such as diabetes.

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Publication Details

Journal
Scientific Reports
Published
2026-02-17
DOI
https://doi.org/10.1038/s41598-025-34777-8
Primary Topic
Acute Ischemic Stroke Management
Type
article
Field-Weighted Citation Impact
0.00

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article

Early surrogates of functional outcome after thrombectomy for MCA-M2 occlusions

Bernd Eckert, Jens Fiehler, Hanna A. Zimmermann, Uta Hanning et al.
Scientific Reports
Acute Ischemic Stroke Management
article

Early surrogates of functional outcome after thrombectomy for MCA-M2 occlusions

Bernd Eckert, Jens Fiehler, Hanna A. Zimmermann, Uta Hanning, Christian Heitkamp, J Röther, Jan Borggrefe, Anna Alegiani, Laurens Winkelmeier, Helge C. Kniep, Matthias Bechstein, Ludger Feyen, Mario Abruscato, Peter D. Schellinger, F Flottmann, Charlotte Pietrock, Jan Hendrik Schäfer, Gabor C Petzold, Arno Reich, Lars Kellert, Steffen Tiedt, Timo Uphaus, Susanne Gellißen, Tobias Boeckh-Behrens, G Thomalla, Tobias Faizy, Omid Nikoubashman, Klaus Gröschel, Fee Keil, Christian Nolte, Lukas Meyer, Gabriel Broocks, Ulrike Ernemann, Sven Thonke, Silke Wunderlich, the German Stroke Registry-Endovascular Treatment (GSR-ET), Franziska Dorn, Alexander Nave
article en

Abstract

The National Institutes of Health Stroke Scale (NIHSS) at 24h is a strong predictor of long-term independence after mechanical thrombectomy for anterior circulation strokes. Its predictive value in patients with M2 segment of the middle cerebral artery (MCA-M2) occlusions, however, remains unclear. This study compares NIHSS scores at admission and 24h and early neurological improvement (ENI) definitions to predict functional outcomes at 90d for M2 occlusions. Patients with isolated MCA-M2 occlusions from the German Stroke Registry (06/2015–12/2021) were analyzed. NIHSS at admission, 24h and ENI definitions were compared for predicting excellent and good outcome, defined as modified Rankin Scale (mRS) 0-1 and 0-2. Factors impairing predictive power were identified based on multivariable logistic regression. Among 1,268 patients, 24h NIHSS showed the highest predictive accuracy, with an area under the curve (AUC) of 0.85 [95% Confidence Interval: 0.83-0.87] for both good and excellent outcomes. Optimal NIHSS thresholds were ≤8 for good and ≤7 for excellent outcomes. Advanced age, higher pre-stroke mRS, diabetes, and higher procedure passes significantly reduced prognostic accuracy. NIHSS at 24h, with thresholds of ≤8 and ≤7, is the best surrogate for predicting good and excellent functional outcomes in MCA-M2 occlusion patients. Prognostic value diminishes with advanced age, pre-stroke disability, and comorbidities such as diabetes.

Scientific ReportsVol. 16(1)
Goethe University Frankfurt (DE), Witten/Herdecke University (DE), Universität Hamburg (DE), Johannes Gutenberg University Mainz (DE), Heidelberg University (DE), University Hospital Bonn (DE), University Hospital Heidelberg (DE), TUM Klinikum (DE), Humboldt-Universität zu Berlin (DE), Asklepios Klinik Altona (DE), MSH Medical School Hamburg – University of Applied Sciences and Medical University (DE), Klinikum Hanau (DE), University Medical Center of the Johannes Gutenberg University Mainz (DE), Helios Hospital Schwerin (DE), Helios Klinikum Krefeld (DE), University Hospital Münster (DE), University Medical Center Hamburg-Eppendorf (DE), Helios Universitätsklinikum Wuppertal (DE), Krankenhaus Reinbek - Startseite (DE), University Hospital Frankfurt (DE), Hertie Institute for Clinical Brain Research (DE), University Medical Centre Mannheim (DE), Johannes Wesling Klinikum Minden (DE), Technical University of Munich (DE), University of Tübingen (DE), Ludwig-Maximilians-Universität München (DE), RWTH Aachen University (DE)
Technische Universität München, RWTH Aachen University, Universitätsklinikum Hamburg-Eppendorf, Universitätsmedizin der Johannes Gutenberg-Universität Mainz
Openalex Percentile: Top 52%
Acute Ischemic Stroke Management
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