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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\u201312\/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 \u22648 for good and \u22647 for excellent outcomes. Advanced age, higher pre-stroke mRS, diabetes, and higher procedure passes significantly reduced prognostic accuracy. NIHSS at 24h, with thresholds of \u22648 and \u22647, 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.<\/jats:p>","DOI":"10.1038\/s41598-025-34777-8","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T09:18:30Z","timestamp":1771319910000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Early surrogates of functional outcome after thrombectomy for MCA-M2 occlusions"],"prefix":"10.1038","volume":"16","author":[{"given":"Helge 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J Stroke 21, 347\u2013349 (2019).","journal-title":"J Stroke"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-34777-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-34777-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-34777-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T18:22:24Z","timestamp":1781634144000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-34777-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,17]]},"references-count":45,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["34777"],"URL":"https:\/\/doi.org\/10.1038\/s41598-025-34777-8","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,17]]},"assertion":[{"value":"26 December 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 December 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 February 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Helge Kniep and Fabian Flottmann are consultants for Eppdata GmbH. Helge Kniep is shareholder of Eppdata GmbH. G\u00f6tz Thomalla received fees as consultant from Acandis, Boehringer Ingelheim, Bayer, and Portola, and fees as lecturer from Acandis, Alexion, Amarin, Bayer, Boehringer-Ingelheim, BMS\/Pfizer, Daiichii Sankyo and Portola. He serves in the board of the TEA Stroke Study and of ESO. Jens Fiehler is consultant for Cerenovus, Medtronic, Microvention, Penumbra, Phenox, Roche and Tonbridge. He serves in the advisory board of Stryker and Phenox. He is stock holder of Tegus Medical, Eppdata and Vastrax. He serves as Associate Editor at JNIS. All other authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"6662"}}