Association of Inflammatory Markers With Symptomatic Intracranial Hemorrhage, Malignant Cerebral Edema, and Poor Functional Recovery in Patients With Acute Ischemic Stroke Undergoing Endovascular Thrombectomy.

BACKGROUND

To investigate the association of inflammatory markers with the risks of clinical outcomes in patients with acute ischemic stroke and large-vessel occlusion who underwent endovascular thrombectomy treatment.

METHODS

A total of 586 patients with acute ischemic stroke and large-vessel occlusion treated with endovascular thrombectomy between May 2017 and February 2025 were enrolled. Patients were stratified into quartiles according to inflammatory markers measured within 24 hours after endovascular thrombectomy, including neutrophil count, neutrophil-to-lymphocyte ratio (NLR), systemic inflammation response index, systemic immune-inflammation index, inflammatory prognostic index, and aggregate index of systemic inflammation. Logistic regression was used to assess associations between these markers and poor functional outcome (modified Rankin Scale score 3-6) at 90 days, symptomatic intracranial hemorrhage within 24 hours, and malignant cerebral edema within 5 days. Receiver operating characteristic curves evaluated predictive performance.

RESULTS

After adjusting for confounders, participants in the highest quartile of each inflammatory marker had significantly higher odds of poor functional recovery (all P for trend≤0.011), symptomatic intracranial hemorrhage (all P for trend≤0.010), and malignant cerebral edema (all P for trend≤0.005), compared with those in the lowest quartile. Receiver operating characteristic curves showed the NLR had the highest discriminative ability to predict poor functional recovery (area under the curve for NLR, 0.692; P<0.001), symptomatic intracranial hemorrhage (area under the curve for NLR, 0.740; P<0.001) and malignant cerebral edema (area under the curve for NLR, 0.739; P<0.001) compared with other inflammatory markers.

CONCLUSIONS

All inflammatory markers, particularly the NLR, were independently associated with an increased risk of poor functional recovery, symptomatic intracranial hemorrhage, and malignant cerebral edema in patients with acute ischemic stroke and large-vessel occlusion after endovascular thrombectomy.