Yoshitaka Nakamura

Aim: The benefit of mechanical thrombectomy (MT) for acute ischemic stroke in patients with pre‐stroke moderate‐to‐severe disability is difficult to evaluate using the modified Rankin Scale (mRS) alone. We developed and evaluated the SMILE‐Stroke score as a patient‐centered outcome measure. Methods: We conducted a retrospective cohort study of 31 patients with pre‐stroke mRS scores of 3–5 who underwent MT. The 10‐point SMILE‐Stroke score, comprising Speech, Mobility, Ingestion, Lavatory, and Engagement domains, was assessed at discharge; a score ≥ 4 was prespecified as favorable. Interrater reliability, convergent validity with the Barthel Index, associations with discharge disposition and mRS, and pre‐stroke SMILE‐Stroke scores were evaluated. Results: Twelve patients (38.7%) achieved a favorable SMILE‐Stroke outcome. Interrater reliability was excellent for the total score (single‐rater intraclass correlation coefficient = 0.957) and dichotomized outcome (Fleiss' κ = 0.863). The score correlated strongly with the discharge Barthel Index (Spearman's ρ = 0.86, p < 0.001) and showed a graded association with discharge disposition (Kruskal–Wallis p = 0.0012). For distinguishing discharge to home/original residence or rehabilitation hospital from long‐term care hospital or death, the SMILE‐Stroke score yielded an AUC of 0.82. Notably, 6 of 19 patients (31.6%) with 90‐day mRS scores of 4–5 achieved a favorable SMILE‐Stroke outcome. Conclusions: The SMILE‐Stroke score was feasible, reproducible, and associated with established functional and discharge outcomes in selected MT‐treated patients with pre‐stroke disability. It may complement the mRS by identifying preserved or regained patient‐centered functional domains within poor mRS categories.

The superiority of percutaneous transluminal angioplasty (PTA) over maximal medical therapy for symptomatic intracranial artery stenosis in terms of secondary prevention has yet to be proved. However, several studies have reported that PTA can improve cortical symptoms and cognitive dysfunctions in selected patients with intracranial artery stenosis. Recently, we experienced a 75‐year‐old woman with acute ischemic stroke due to right middle cerebral artery stenosis, presenting with hemispatial neglect of the left side as well as left hemiparesis, which was treated with PTA in the subacute stage. She showed improvement of the hemispatial neglect after PTA, which accelerated the rehabilitation, resulting in a good prognosis. It is known that the presence of neglect syndrome hampers rehabilitation and is associated with a poor outcome. To our knowledge, this is the first report of the performance of PTA to improve hemispatial neglect for successful rehabilitation.