Prognostic Evaluation of Acute Ischemic Stroke Patients After Mechanical Thrombectomy Incorporating Imaging, Inflammatory, and Rehabilitation Aspects

Aim

We aimed to perform a prognostic evaluation for patients with acute ischemic stroke after mechanical thrombectomy (MT) incorporating imaging, inflammatory, and rehabilitation aspects.

Methods

A retrospective cohort analysis of patients with acute ischemic stroke (AIS) after mechanical thrombectomy (MT) was conducted, systematically evaluating baseline demographics, neuroimaging features, hematological inflammatory indices, and time to start rehabilitation. Prognostic correlations were examined using multivariate logistic regression, with poor functional outcome defined as 90-day modified Rankin Scale (mRS) >2. Model discrimination was assessed via receiver operating characteristic (ROC) analysis of the composite prediction framework.

Results

The analytical cohort comprised 144 subjects. Five independent predictors of unfavorable outcomes emerged: pre-existing hypertension (adjusted Odds Ratio [aOR] 6.48, 95% Confidence Interval [CI] 1.03–40.80), lower baseline Alberta Stroke Program Early CT Score (ASPECTS) (aOR 0.18, 95% CI 0.06–0.49), elevated NLR (aOR 1.27, 95% CI 1.11–1.46), extended onset-to-reperfusion time (OTR) (per minute aOR 1.01, 95% CI 1.01–1.02), and delayed starting rehabilitation (aOR 2.30, 95% CI 1.52–3.46). The multivariable model demonstrated excellent discriminative capacity (area under the curve [AUC] 0.964, 95% CI 0.940–0.988).

Conclusions

Beyond successful recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] 2b-3), functional outcomes in patients with acute ischemic stroke treated with mechanical thrombectomy were independently influenced by factors across the three core domains of our prognostic framework: imaging (baseline ASPECTS), inflammation (elevated neutrophil-to-lymphocyte ratio, NLR), and rehabilitation (delayed starting rehabilitation). Additional significant clinical variables included pre-existing hypertension and longer onset-to-reperfusion time (OTR). These findings support the potential value of a multidimensional prognostic assessment integrating imaging, inflammatory, and rehabilitation aspects in patients with acute ischemic stroke after mechanical thrombectomy.