BACKGROUND: The prevalence and titer patterns of anti-neuronal antibodies in patients with large vessel occlusion (LVO) strokes remain unclear. The relationship between anti-neuronal antibodies and ischemic stroke prognosis remains debated. This cohort study aimed to clarify the prevalence and titer characteristics of anti-neuronal antibodies in patients with anterior circulation LVO stroke and to examine their effect on outcomes following endovascular treatment. METHOD: We retrospectively analyzed data from consecutive patients with first-ever acute ischemic stroke due to anterior circulation LVO admitted to Xi'an No. 3 Hospital (China) between November 2019 and September 2023. Logistic regression and propensity score matching were utilized to explore the relationship between anti-neuronal antibodies and outcomes in anterior circulation LVO stroke patients. Sensitivity analysis was conducted by calculating E-values and adjusting the caliper width for propensity score matching. RESULTS: Among 153 patients, 28 tested positive for antibodies against neuronal antigens, with anti-N-methyl-D-aspartate receptor 1 (NMDAR1)-IgM being the most common. Anti-dipeptidyl-peptidase (DPPX)-IgG showed the highest titers, while anti-NMDAR1-IgM was predominantly low-titer. The presence of anti-neuronal antibodies is significantly and negatively correlated with a favorable prognosis following endovascular treatment in stroke patients with anterior circulation LVO. (ORs: 0.12-0.28, all p < 0.05). E-values ranged from 3.19 to 5.22, and adjusting the caliper to 0.1 confirmed the robustness of the study's findings. CONCLUSIONS: Anti-neuronal antibodies may be associated with an increased risk of futile recanalization in patients with anterior-circulation large-vessel occlusion stroke.
Gao et al. (2026) studied this question.