Predictors of delayed neurological improvement in patients with large core infarctions undergoing endovascular treatment

OBJECTIVE: Some patients with large core infarctions who underwent endovascular treatment (EVT) still achieved favorable long-term outcomes despite the absence of neurological improvement in the acute phase. The underlying reasons for this phenomenon remain unclear. This study aimed to investigate the incidence and predictors of delayed neurological improvement (DNI) in this patient population. METHODS: Patients with large core infarctions who received EVT were derived from a prospective, observational, nationwide multicenter registry. Acute phase neurological improvement (APNI) was defined as a decrease of ≥4 points in the National Institutes of Health Stroke Scale (NIHSS) score between admission and day 5-7. DNI was defined as achieving 90-day favorable outcomes in the absence of APNI. Multivariate logistic regression was used to analyze independent predictors of DNI. RESULTS: Among 490 patients with large core infarctions who underwent EVT, 277 (56.5%) did not experience APNI. Of these, 39 (14.1%) patients achieved favorable long-term clinical outcomes and constituted the DNI group. Younger age, male sex, lower baseline NIHSS score, good collateral circulation, and shorter puncture to reperfusion time were independent predictors of DNI. CONCLUSION: DNI occurred in 14.1% of patients with large core infarctions undergoing EVT. Optimizing modifiable factors, such as reducing puncture to reperfusion time and improving collateral circulation, is crucial for enhancing patient outcomes. These findings have important implications for refining clinical management strategies and improving prognosis in this patient population.