ArticleFrontiers in neurology2026
Sequential NIHSS-NLR monitoring after endovascular thrombectomy: malignant cerebral oedema and inflammatory futility in a two-phase derivation study.
Article in Frontiers in neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Successful reperfusion after endovascular thrombectomy (EVT) does not guarantee recovery. Malignant cerebral oedema (MCE) complicates approximately one in eight patients, and static pre-procedural models do not capture evolving post-reperfusion risk. We evaluated a two-phase sequential clinical-inflammatory monitoring framework. Methods: We conducted a retrospective consecutive-patient cohort study at Xiangya Hospital (2021-2025) including 306 successfully reperfused EVT patients. Phase 1 combined the 24-h NIHSS trajectory with neutrophil-to-lymphocyte ratio (NLR) direction for clinically ascertained MCE risk. Ridge-penalised logistic models were internally validated using Harrell bootstrap correction. Exploratory Phase 2 combined 72-h NLR with CT-perfusion anatomy for futile recanalisation (90-day mRS ≥3). Results: MCE occurred in 39 patients (12.7%), all co-occurring with early neurological deterioration. NIHSS worsening was the dominant predictor (aOR 6.95, 95% CI 3.63-14.46; Discussion: Because MCE ascertainment was clinically triggered and adjudication was unblinded to NIHSS trajectory, Phase 1 identifies a clinical-inflammatory risk pattern rather than an independent radiological predictor. NLR direction functions primarily as a complication-profile stratifier. Prospective multicentre validation with blinded radiological adjudication is required before clinical or trial-design application.
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