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Updated: May 5, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Analysis of Prognostic Risk Factors in Patients with Complete Revascularization After Thrombectomy for Acute Anterior
Qingjiang Yang1, Zhitao Xie2, Xiaojun Ha2
1The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan, China; Department of Neurology, Foshan Hospital of Traditional Chinese Medicine, Foshan, China.
Insights
Neutrophil-to-lymphocyte ratio (NLR), 7-day National Institute of Health Stroke Scale (NIHSS) score, and diabetes history are key predictors of poor outcomes in acute stroke patients treated with endovascular therapy. These factors help identify patients at higher risk for functional decline after treatment.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Biomarkers and Diagnostics
Background:
- Acute anterior circulation large vessel occlusion stroke requires timely endovascular treatment to restore blood flow.
- Identifying prognostic factors is crucial for optimizing patient management and predicting outcomes after successful reperfusion (mTICI grade 3).
Purpose of the Study:
- To analyze prognostic risk factors for patients with acute anterior circulation large vessel occlusion stroke.
- To evaluate the predictive value of inflammatory markers, clinical scores, and patient history on functional outcomes post-endovascular treatment.
Main Methods:
- Retrospective analysis of 103 patients with acute ischemic stroke and mTICI=3 grade after endovascular treatment.
- Collection of baseline, risk factor, test, and surgical data.
- Multivariate logistic regression and receiver operating characteristic (ROC) curve analysis to identify independent predictors of 90-day poor functional outcome (modified Rankin score >2).
Main Results:
- Neutrophil-to-lymphocyte ratio (NLR) at 24 hours post-surgery (OR=1.10), 7-day National Institute of Health Stroke Scale (NIHSS) score (OR=1.15), and history of diabetes (OR=9.60) were independently associated with poor prognosis.
- ROC analysis showed predictive values for NLR (AUC=0.687), NIHSS (AUC=0.826), and diabetes history (AUC=0.667).
- A combined model of these three markers achieved a high predictive accuracy (AUC=0.889).
Conclusions:
- NIHSS score at 7 days, NLR within 24 hours, and diabetes history are significant independent predictors of poor prognosis in patients achieving mTICI grade 3 after endovascular therapy for acute anterior large vessel occlusion stroke.
- A combination of high NLR (≥6.7), elevated NIHSS score (≥4.5), and a history of diabetes identifies patients with a substantially higher likelihood of poor functional outcomes.
Objective:
Prognostic risk factors were analyzed for patients with acute anterior circulation large vessel occlusion stroke who achieved modified Treatment in Cerebral Ischemia (mTICI) 3 grade by endovascular treatment.
Methods:
Patients with Acute ischemic stroke with mTICI=3 grade after endovascular treatment from June 2019 to September 2024, at the Eighth Clinical College of Guangzhou University of Traditional Chinese Medicine, were retrospectively analyzed. Data related to patients' baseline data, risk factors, test data, and surgical data were collected, and the primary endpoint was 90-day poor functional outcome, defined as patients' modified Rankin score >2 at 90 days after surgery. The predictive effect was evaluated using receiver operating characteristic curve analysis, and multivariate logistic regression analysis was used to explore the independent correlation between inflammatory markers and prognosis.
Results:
A total of 103 eligible patients were included. Multivariate logistic regression analysis showed that the neutrophil-to-lymphocyte ratio (NLR) (odds ratio [OR] = 1.10, 95% confidence interval [CI]: 1.01∼1.20, P = 0.021) at 24 hours after surgery, 7-day National Institute of Health stroke scale (NIHSS) score: (OR = 1.15, 95% CI: 1.07∼1.23, P < 0.001), diabetes history: (OR = 9.60, 95% CI: 2.41∼38.26, P = 0.001), was independently associated with poor prognosis in patients with mTICI = grade 3 after endovascular therapy. Receiver operating characteristic curve analysis: NLR (area under the curve [AUC] = 0.687, 95% CI: 0.584∼0.790) at 24 hours after surgery, NIHSS (AUC = 0.826, 95% CI: 0.746∼0.906), and diabetes history (AUC = 0.667, 95% CI: 0.563∼0.771). Three-marker combined predictive indicators (AUC = 0.889, 95%CI: 0.829∼0.949) CONCLUSIONS: In patients with acute anterior large vascular occlusive stroke with mTICI = grade 3 after endovascular therapy, NIHSS score at 7 days after surgery, NLR within 24 hours after surgery, and history of diabetes were independent influencing factors for poor prognosis. Patients with a history of diabetes who had a NLR ≥6.7 within 24 hours and a NIHSS score ≥4.5 at 7 days after surgery were more likely to have a poor prognosis.
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