ORIGINAL RESEARCH article
Front. Neurol.
Sec. Stroke
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1663299
Systemic Immune-Inflammation Index Associated with Functional Outcomes After Endovascular Thrombectomy in Anterior Circulation Acute Ischemic Stroke
Provisionally accepted
- 1Taizhou Hospital of Zhejiang Province, Linhai, China
- 2Wenzhou Medical University, Wenzhou, China
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Background: Many patients undergoing endovascular thrombectomy (EVT) for anterior circulation acute ischemic stroke experience poor outcomes despite successful recanalization. The systemic immune-inflammation index (SII) integrates multiple inflammatory pathways. We aimed to evaluate the association between SII and clinical outcomes in anterior circulation stroke patients undergoing EVT. Methods: This retrospective study included 741 consecutive patients who underwent EVT for anterior circulation stroke at a tertiary center between January 2021 and December 2024. SII was calculated as platelet count × neutrophil count / lymphocyte count within 24 hours. The primary outcome was poor functional outcome (modified Rankin Scale 3-6) at 3 months. The safety endpoint was symptomatic intracranial hemorrhage (sICH). Associations were examined using multivariable logistic regression and cubic spline analyses. Results: The median SII was 1247.9 [IQR: 804.9-2127.1]. Poor functional outcome occurred in 317 (42.8%) patients. After adjustment, log-transformed SII was independently associated with poor functional outcome (OR 1.428, 95% CI 1.159-1.759, P<0.001). Patients in the highest SII tertile (>1809) had significantly higher odds of poor outcome versus lowest tertile ( ≤928.25) (OR 1.73, 95% CI 1.18-2.52, P=0.005), with significant trend across tertiles (P for trend=0.005). However, SII showed no association with symptomatic intracranial hemorrhage (OR 1.32, 95% CI 0.84-2.07, P=0.235). The SII-outcome association was consistent across subgroups. Restricted cubic spline analysis confirmed a linear dose-response relationship (P for non-linearity=0.173). Conclusions: In anterior circulation stroke patients undergoing EVT, elevated SII is independently associated with poor functional outcome but not symptomatic hemorrhagic complications.
Keywords: systemic immune-inflammation index, Endovascular thrombectomy, Anterior circulation stroke, functional outcome, Inflammation
Received: 10 Jul 2025; Accepted: 08 Oct 2025.
Copyright: © 2025 Han, Miao, Zheng, Hu and Zhong. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jia-Wei Zhong, zhongjw4804@enzemed.com
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