Abstract Details

Title Role of Immune Indices, NLR, SII, PLR and SIRI in Predicting Post-Mechanical Thrombectomy (MT) outcomes

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P4 - Poster Session 4 (8:00 AM-9:00 AM)

Poster/Presentation
Number 5-008

Objective We retrospectively reviewed MT cases at our institution to assess whether immune indices predict clinical/radiographic features and post-MT outcomes.

Background MT is an established treatment for acute ischemic stroke (AIS). With expanding eligibility windows and improved devices, outcome prediction and patient selection are crucial. Increasing evidence implicates systemic and intra-/peri-thrombus inflammation in AIS prognosis. Among systemic immune indices, neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), platelet-to-lymphocyte ratio (PLR), and systemic inflammation response index (SIRI) predict AIS outcomes, but their role in MT remains unclear.

Design/Methods

We studied 68 MT patients treated between 9/2023-12/2024 at UC-Irvine. Demographics and clinical variables were summarized using means. Indices: NLR = neutrophils/lymphocytes (L), SII = (platelets × neutrophils)/L, SIRI = (neutrophils × monocytes)/L, PLR = platelets/L. Predictive values were calculated against TICI, mRS, LOS, and hemorrhagic transformation (HE) using 2×2 tables and reported 95% CIs. Thresholds were defined by ROC-derived Youden index or clinical cutoffs. Fisher’s exact test with FDR correction assessed significance.

Results

Several indices showed significant predictive value (FDR <0.05). For poor reperfusion (TICI ≤2b), NLR ≥2.28, SII ≥470, and SIRI ≥0.92 yielded moderate PPVs (47–51%) and good NPVs (76–82%); raw p-values (0.027–0.045) trended toward significance after FDR (0.060). For HE (PH1/PH2), all indices were predictive, with NPVs 96–100%. NLR (≥3.64), PLR (≥265), and SIRI (≥1.33) predicted prolonged LOS >7 days (PPVs 65–100%). At discharge, NLR (≥4.7), SII (≥721), and SIRI (≥1.1) predicted discharge mRS ≥3 (PPVs 86–93%), though NPVs were low; 90-day mRS results trended similarly, with SIRI showing strongest NPV (86%).

Conclusions Elevated immune indices were consistently associated with HE and longer hospitalization, with trends toward poor reperfusion and functional outcomes, whereas lower values strongly excluded adverse events such as parenchymal hematoma. These leukocyte-based indices may improve MT candidate selection, as inflammation likely contributes substantially to AIS pathogenesis and treatment response.

Authors/Disclosures
Yasmin Ghochani, MD, PhD (University of California, Los Angeles Department of Neurology) PRESENTER	Dr. Ghochani has nothing to disclose.
Chloe Villars	Ms. Villars has nothing to disclose.
Kevin Gramajo-Aponte, Medical Student	Mr. Gramajo-Aponte has nothing to disclose.
Sookyung Oh, MD (UC Irvine Medical Center)	Dr. Oh has nothing to disclose.
Brenton Maisel, MD, PhD (UCI Health)	Dr. Maisel has nothing to disclose.
Andrew J. Lee, MD	Dr. Lee has nothing to disclose.
Masaki Nagamine, MD (University of California, Irvine Medical Center)	Dr. Nagamine has nothing to disclose.
Jay Shah, MD (UCI Neurology)	Dr. Shah has nothing to disclose.
Wengui Yu, MD, PhD (UC Irvine, Neurology Dept)	Dr. Yu has nothing to disclose.
Mohammad Shafie, MD (Department of Neurology - University of California, Irvine)	Dr. Shafie has nothing to disclose.

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