To investigate the association between peripheral blood inflammatory biomarkers and 90-day functional outcomes in patients with acute ischemic stroke (AIS) with large ischemic cores versus non-large ischemic cores undergoing endovascular therapy (EVT).

This retrospective study consecutively enrolled patients with anterior circulation AIS who underwent EVT at the First Affiliated Hospital of Nanchang University between November 2019 and January 2025. According to ischemic core volume, patients were categorized into the large ischemic core group (ischemic core volume ≥50 mL) and the non-large ischemic core group (ischemic core volume ＜50 mL). Furthermore, based on the 90-day modified Rankin scale (mRS) scores, each group was subdivided into a functionally independent group (mRS score 0 to 2) and a non-functionally independent group (mRS score ＞2). Demographic characteristics, medical history, clinical data, neuroimaging findings, laboratory parameters—including inflammatory biomarkers [neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and systemic inflammatory response index (SIRI)], and follow-up data were compared between groups. Continuous variables were analyzed using the student's t-test or the Mann-Whitney U test, while categorical variables were compared using the Chi-square test or Fisher's exact test. Univariate and multivariate Logistic regression analyses were performed to identify independent predictors of 90-day functional independence.

A total of 913 patients with anterior circulation AIS who underwent EVT were included in the final analysis. Among them, 270 patients had large ischemic cores, including 73 patients with functional independence and 197 patients without functional independence; 643 patients had non-large ischemic cores, including 335 patients with functional independence and 308 patients without functional independence. In the large ischemic core group, the median NLR values were 4.63 (2.85, 7.60) in the functional independence group and 5.89 (3.99, 10.00) in the non-functional independence group, with a significant difference between groups (Z=-2.518, P=0.012). However, no significant differences were observed for LMR [3.25 (2.16, 5.24) vs 3.17 (2.22, 4.26), Z=-0.575, P=0.565] or SIRI [1.93 (0.92, 3.61) vs 2.38 (1.35, 3.84), Z=-1.584, P=0.113]. In the non-large ischemic core group, significant differences were observed between the functional independence and non-functional independence groups in NLR [4.63 (3.07, 6.86) vs 5.27 (4.02, 8.93), Z=-3.521, P＜0.001], LMR [3.50 (2.74, 4.45) vs 3.32 (2.27, 4.24), Z=-2.806, P=0.005], and SIRI [1.88 (1.09, 2.65) vs 2.00 (1.34, 3.39), Z=-3.153, P=0.002]. Multivariate Logistic regression analysis demonstrated that NLR, LMR, and SIRI were not significantly associated with 90-day functional independence in patients with large ischemic cores undergoing EVT (all P＞0.05). In contrast, NLR, LMR, and SIRI were independent predictors of 90-day functional independence in patients with non-large ischemic cores undergoing EVT (all P＜0.05).

NLR, LMR, and SIRI are independent predictors of 90-day functional independence in patients with anterior circulation AIS and non-large ischemic cores undergoing EVT. However, these inflammatory biomarkers lack significant predictive value in patients with large ischemic cores.