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Original research
Follow-up neutrophil-lymphocyte ratio after stroke thrombectomy is an independent biomarker of clinical outcome
  1. Moustafa Aly1,
  2. Ramez N Abdalla1,2,
  3. Ayush Batra3,
  4. Ali Shaibani1,4,
  5. Michael C Hurley1,4,
  6. Babak S Jahromi1,4,
  7. Matthew B Potts1,4,
  8. Sameer A Ansari1,3,4
  1. 1Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  2. 2Radiology, Ain Shams University Faculty of Medicine, Cairo, Egypt
  3. 3Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  4. 4Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  1. Correspondence to Dr Sameer A Ansari, Radiology, Neurology, and Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; s-ansari{at}


Background Admission neutrophil-lymphocyte ratio (NLR) is significantly correlated to clinical outcomes in acute ischemic stroke (AIS). We investigated follow-up NLR and temporal changes in NLR after endovascular thrombectomy (EVT) with respect to successful revascularization, clinical outcomes, symptomatic intracranial hemorrhage (sICH) and mortality.

Methods Retrospective analysis of EVT for anterior circulation emergent LVO was performed with both admission (NLR1) and 3–7 day follow-up NLR (NLR2) laboratory data. Patient demographics, National Institutes of Health Stroke Scale (NIHSS) presentations, reperfusion efficacy (modified Thrombolysis in Cerebral Infarction (mTICI) score), sICH, and clinical outcomes (modified Rankin Scale (mRS)) at 90 days were studied. Univariate analyses correlated NLR1, NLR2, and temporal change in NLR (NLR2-NLR1) with successful reperfusion (mTICI ≥2b), favorable outcomes (mRS ≤2), sICH, and mortality. Multivariable logistic regression model evaluated the independent effects of NLR2 on favorable outcomes.

Results 142 AIS patients with median NIHSS 17 underwent EVT within 24 hours, and met NLR laboratory inclusion criteria. Lower follow-up NLR2 and less temporal change in NLR over 3–7 days, but not admission NLR1, inversely correlated with successful reperfusion (p<0.05) and favorable clinical outcomes (p<0.001). Higher follow-up NLR2 and greater temporal change in NLR was significantly associated with sICH and mortality (p≤0.05). In multivariable logistic regression, lower follow-up NLR2 remained a predictor of favorable outcomes (OR 0.785, p=0.001), independent of age or successful reperfusion.

Conclusions Follow-up NLR is a readily available and modifiable biomarker that correlates with the degree of reperfusion after mechanical stroke thrombectomy. Lower follow-up NLR2 at 3–7 days is associated with successful reperfusion and an independent predictor of favorable clinical outcomes, with reduced risk for sICH and mortality.

  • stroke
  • inflammatory response
  • thrombectomy
  • inflammation
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  • Contributors All authors of this manuscript have contributed to the work as per the following ICMJE recommendations:"Substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data. Drafting the work or revising it critically for important intellectual content. Final approval of the version published. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved." SAA is the guarantor of the manuscript and conceptualized the work. SAA, MA, AB, RNA performed the literature search and/or contributed to manuscript writing. SAA, AS, MCH, BSJ and MBP identified and managed the cases, performed the procedures, and contributed to manuscript editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. N/A.

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