{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T15:04:44Z","timestamp":1789139084153,"version":"build-2803163510"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The impact of endovascular therapy (EVT) timing within the 24-h window on tissue injury and post-ischemic inflammation in large-vessel occlusion stroke remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In a single-center prospective cohort, 216 anterior circulation large-vessel occlusion patients treated with EVT\u202f\u2264\u202f24\u202fh were stratified by onset-to-groin time: 0\u20136\u202fh (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f74), 6\u201312\u202fh (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f72), and 12\u201324\u202fh (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f70). Serial IL-6, TNF-\n                      <jats:italic>\u03b1<\/jats:italic>\n                      , IL-1\u03b2, MMP-9, C-reactive protein, and neutrophil-to-lymphocyte ratio were measured to 72\u202fh; reperfusion quality, final infarct volume, infarct progression, NIHSS change, and 90-day modified Rankin Scale (mRS) were compared.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Baseline demographics, risk factors, stroke severity, and inflammatory profiles were similar across groups. Earlier EVT yielded higher mTICI 2b\u20133 rates and more first-pass effect, with fewer device passes and shorter procedures. Final infarct volume increased stepwise with delay (38.7, 51.3, and 64.5\u202fmL in the 0\u20136\u202fh, 6\u201312\u202fh, and 12\u201324\u202fh groups), paralleled by greater infarct progression. NIHSS improvement at 24\u202fh and day 7 was greatest in the 0\u20136\u202fh group, and functional independence at 90\u202fdays declined with later treatment (mRS 0\u20132: 64.9%\n                      <jats:italic>vs<\/jats:italic>\n                      50.0%\n                      <jats:italic>vs<\/jats:italic>\n                      35.7%). Symptomatic intracranial hemorrhage, procedural complications, and in-hospital mortality were low and comparable. Patients treated within 0\u20136\u202fh showed blunted peaks and faster resolution of IL-6, MMP-9, C-reactive protein, and neutrophil-to-lymphocyte ratio, consistent with a more favorable neuroinflammatory trajectory. These associations remained consistent in adjusted and sensitivity analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Within 24\u202fh, earlier EVT was associated with more favorable reperfusion metrics, smaller infarct burden, lower circulating inflammatory biomarkers, and better 90-day functional outcome, without an apparent increase in major safety events. Given the observational design, these findings should be interpreted as associations rather than causal effects.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1759402","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T04:12:24Z","timestamp":1774843944000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Earlier endovascular therapy within 24\u202fh of ischemic stroke is associated with attenuated systemic inflammation and better neurological recovery"],"prefix":"10.3389","volume":"17","author":[{"given":"Yan","family":"Yan","sequence":"first","affiliation":[{"name":"Department of Neurology VI, Xingtai People\u2019s Hospital","place":["Xingtai, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Qiao","sequence":"additional","affiliation":[{"name":"Department of Neurology IV, Xingtai People\u2019s Hospital","place":["Xingtai, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tengfei","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Neurology I, Longyao County Hospital","place":["Longyao, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liyun","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology IV, Xingtai People\u2019s Hospital","place":["Xingtai, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology IV, Xingtai People\u2019s Hospital","place":["Xingtai, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1016\/j.amjms.2025.06.005","article-title":"Endovascular therapy in acute ischemic stroke: a six-year national assessment of utilization and outcomes","volume":"370","author":"Bahar","year":"2025","journal-title":"Am J Med Sci"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"109101","DOI":"10.1016\/j.clineuro.2025.109101","article-title":"Endovascular thrombectomy for acute ischemic stroke due to medium or distal vessel occlusion: a systematic review and meta-analysis","volume":"257","author":"De Lima Loiola","year":"2025","journal-title":"Clin Neurol Neurosurg"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1016\/s0140-6736(25)00194-1","article-title":"Efficacy and safety of nerinetide in acute ischaemic stroke in patients undergoing endovascular thrombectomy without previous thrombolysis (ESCAPE-NEXT): a multicentre, double-blind, randomised controlled trial","volume":"405","author":"Hill","year":"2025","journal-title":"Lancet (London, 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