Background: Post-stroke systemic inflammation has been proposed as a negative predictor for functional recovery, and anti-inflammatory agents have been explored as potential neuroprotective agents after stroke reperfusion treatments. Yet the incidence and impact of post-stroke inflammation on outcomes after endovascular thrombectomy (EVT) for large vessel occlusion (LVO) stroke are unclear. Methods: A retrospective analysis of LVO stroke patients treated with EVT from 2016 to 2024 was conducted. White blood cell (WBC) counts before and after EVT were collected, and those with post-EVT reactive leukocytosis (PERL) were compared to those without significant WBC elevations. Patients with missing data were excluded. The primary outcome was a 90-day modified Rankin scale (mRS). Patient demographics, time from last known well, stroke severity, infarct burden, comorbidities, and hemorrhagic transformation were also captured. Results: 421 patients were included; mean age was 67.3 years; 51% were male; 123 (29.2%) experienced PERL. PERL patients had lower rates of smoking (35.2% vs. 47.1%, p=0.019), higher rates of antiplatelet use (39.8% vs. 28.9%, p=0.028), and lower pre-EVT WBC counts (mean 8.1 vs. 9.6 thousand cells per microliter, p0.05). PERL was associated with higher rates of hemorrhagic transformation (23.6% vs. 15.4%, p=0.047), larger shifts towards worse mRS (median 3 vs. 2, p<0.001), lower rates of functional independence (39.0% vs. 53.0%, p=0.009), and higher rates of bedridden state or death (26.0% vs. 14.1%, p=0.003). After multivariable adjustments, including hemorrhagic transformation, PERL remained significantly associated with higher odds of worse mRS (common OR 2.46 95%CI 1.60-3.80, p<0.001), lower odds of functional independence (OR 0.45 95%CI 0.24-0.84, p=0.013), and higher odds of bedridden state or death (OR 2.78 95%CI 1.26-6.26, p=0.012). Conclusion: PERL is a common post-EVT phenomenon among LVO stroke patients, is largely unassociated with stroke or procedural characteristics, and is significantly associated with worse post-EVT outcomes independent of hemorrhagic transformation. These findings support future investigations targeting post-EVT inflammation to improve neurological outcomes.
Cahill et al. (Thu,) studied this question.
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