Background and Aim: Lower baseline NIHSS and mRS at 90 days have independently proved as robust predictors of good clinical outcome in stroke patients. However, NIHSS may not be as reliable in predicting outcomes in PCA strokes and making “cut point” adjustments in NIHSS may better reflect disability. We aimed to identify such an appropriate NIHSS "cut point" as means for inclusion in future clinical trials by assessment of disability at 90 days. Methods: Manual sort of MCA and PCA based on a standard atlas and imaging review was performed. Patients presenting with acute ischemic stroke were included and a 90-day mRS was obtained. TIA, ICH, SAH, acute ischemic stroke involving the ACA territory or the brainstem were excluded. We defined our outcome ratio as the baseline NIHSS divided by mRS at 90 days, with a lower score indicative of a more "potent" cause of disability. Results: We divided our data into two cohorts as follows: MCA cohort had 487 patients with an average NIHSS of 8.8 and an average mRS of 2.5. The outcome ratio overall was 3.52 (Right: 3.15, Left: 3.875, bilateral: 2.82). PCA cohort had 54 patients with an average NIHSS of 5.1 and an average mRS of 2.3. The outcome ratio overall was 2.21 (Right: 1.54, Left: 2.44, bilateral: 4.40). Conclusions: In our cohort, PCA infarcts had less rehabilitation potential and may benefit more from inclusion in trials with lower NIHSS thresholds.
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