NLR–FAR Index as a Superior Predictor of 30-Day Functional Outcome after Endovascular Thrombectomy in Acute Ischemic Stroke

Xuchen Meng¹Weijie Zhong¹Ding-Zhong Tang²Zixian Mei¹Tanjun Deng¹Xin Lv¹Jiexi Xiao¹Yueqi Zhu^3*Yi Li^1*

• ¹Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
• ²Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, China
• ³Shanghai 6th Peoples Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China

Objective: To determine whether the neutrophil-to-lymphocyte ratio–fibrinogen-to-albumin ratio (NLR–FAR) Index predicts long-term prognosis in acute ischemic stroke patients undergoing endovascular thrombectomy (EVT). Background: Systemic inflammatory imbalance contributes to ischemic brain injury, but the combined effect of NLR and FAR on EVT outcomes has remained unclear. Methods: We retrospectively analyzed patients treated with EVT. A composite inflammatory-coagulation index, designated as the NLR–FAR Index, was defined as the product of NLR and FAR. The primary endpoint was 30-day functional outcome defined by the modified Rankin Scale (mRS), with poor outcome as mRS ≥3. Logistic regression and restricted cubic spline analyses were used to assess associations. Results: Of 254 patients, 121 (47.6%) had poor outcomes. Higher NLR, FAR, and especially NLR–FAR Index were significantly associated with poor prognosis. The NLR–FAR Index showed the strongest predictive effect (adjusted OR=1.910, 95% CI: 1.079-3.384). Restrictive cubic spline analysis shows that when the NLR-FAR index exceeds the threshold of 0.62, the risk of adverse outcomes at 30 days begins to significantly increase. Conclusion: The NLR–FAR Index independently predicts functional outcomes after EVT and outperforms NLR or FAR alone. This accessible biomarker may aid early risk stratification and individualized management in acute ischemic stroke.