Predicting poor prognosis risk after endovascular thrombectomy for acute ischemic stroke: combination of TMAO and white matter lesions

To investigate the combined predictive value of plasma trimethylamine N-oxide (TMAO) and white matter lesions (WMLs) burden for 90-day prognosis after endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) with large vessel occlusion (AIS-LVO). This retrospective study included 202 AIS-LVO patients from six centers who achieved successful recanalization after EVT between February 2023 and October 2024. Patients were categorized into good (mRS ≤ 3, n = 89) and poor prognosis (mRS > 3, n = 113) groups based on 90-day modified Rankin Scale (mRS). Univariate and multivariable logistic regression analyses were performed to identify independent predictors of poor prognosis. Receiver operating characteristic (ROC) curves evaluated the predictive performance of combined TMAO and WML scores. DeLong's test confirmed that combining TMAO with the Aharon Peretz score improves the predictive value for poor outcomes over traditional risk factors (NIHSS score and age). The poor prognosis group exhibited significantly higher age, TMAO levels, creatinine, Aharon Peretz scores and NIHSS compared to the good prognosis group (p < 0.05). Multivariable analysis identified TMAO (OR = 2.854, 95%CI: 1.693-4.812), and Aharon Peretz score (OR = 1.881, 95%CI: 1.384-2.558) as new independent predictors (p < 0.05). The combination of TMAO and Aharon Peretz scores predicted poor prognosis with an AUC of 0.786 (95%CI: 0.723-0.848). TMAO and Aharon Peretz scores are independent risk factors for poor short-term prognosis after EVT in patients with AIS. The combination of TMAO and Aharon Peretz scores more accurately predicts the occurrence of short-term poor prognosis after EVT in patients with AIS.