Abstract Body:
Introduction: Despite evidence showing overall improvement of post-stroke outcomes following endovascular therapy (EVT), existing literature on comparative recovery rates of different stroke deficits is limited. We hypothesized that the rate of change in aphasia may vary compared to other neurological deficits in stroke patients post successful EVT.

Methods: We performed a retrospective analysis of acute stroke patients at a single comprehensive stroke center who presented with aphasia and underwent EVT from 2022 to 2023 (n=122). Total and itemized NIHSS scores were documented at three separate timepoints: admission, immediately post-EVT, and at discharge; NIHSS scores were normalized by dividing each score by its maximum possible value. We also investigated the NIH Cog-4 and Motor-6 as summative scores representing domain specific cognitive and motor deficits, respectively. We analyzed the effects of TNK and successful reperfusion (TICI 2B to 3 vs 0 to 2A) on the normalized stroke deficit scores with a linear mixed-effect regression model adjusted for measurement timepoint with subjects as a random effect. We extracted each variable’s beta coefficient, representing the variable’s average effect on NIH score (e.g. average change in score from admission to post-EVT). Recovery was represented by percent changes in beta coefficient by successful vs unsuccessful reperfusion. We also evaluated the percent change in beta coefficients with a stratified analysis of ≥ TICI 2B using permutation testing (500 permutations) to test the null hypothesis that there are no change in beta coefficients between subgroups (p<0.05).

Results: Successful reperfusion (≥ TICI 2b) was associated with a decline in aphasia impairment post-EVT (Beta -7.5%; SE 0.038; p 0.049) and at discharge (Beta -22.6%; SE 0.038; p< 0.01) versus unsuccessful reperfusion (< TICI 2b) post-EVT (Beta -2.6%; SE 0.112; p 0.821) and discharge (Beta -7.7%; SE 0.112; p 0.499). A similar decline in impairment with successful reperfusion was also observed for Cognition (p<0.01), Motor (p 0.027), and Global (p 0.001) scores (Figure 1).

Conclusions: Successful reperfusion was associated with a significant decline in impairment in aphasia as well other itemized domains for stroke patients post-EVT and at time of discharge. Future research in larger, multicenter datasets and incorporating longitudinal outcomes may help further differentiate long term recovery of individualized stroke deficits post treatment.