{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T06:12:29Z","timestamp":1788415949486,"version":"build-2803163510"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"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>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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 \u22653).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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;\n                      <jats:italic>E<\/jats:italic>\n                      -value 13.4; corrected AUC 0.791). NLR direction provided minimal incremental discrimination (DeltaAUC +0.008, 95% CI -0.007 to +0.020) but separated complication profiles: concurrent NIHSS worsening and NLR rise identified an oedema-enriched subgroup (MCE 26.9%; NNM 3.7), whereas non-rising NLR among worsening patients identified a haemorrhage-enriched subgroup (sICH 37.7%). At 72 h, favourable anatomy with elevated NLR defined a candidate inflammatory futility phenotype with lower functional independence (57.3% vs 84.2%; corrected AUC 0.631, upper bound by construction).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1898491","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:14:30Z","timestamp":1788412470000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Sequential NIHSS\u2013NLR monitoring after endovascular thrombectomy: malignant cerebral oedema and inflammatory futility in a two-phase derivation study"],"prefix":"10.3389","volume":"17","author":[{"given":"Hesham A.","family":"Alyamani","sequence":"first","affiliation":[{"name":"Department of Neurology, Xiangya Hospital, Central South University","place":["Changsha, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anter M. A.","family":"Nasser","sequence":"additional","affiliation":[{"name":"Department of Neurology, Thamar University","place":["Dhamar, Yemen"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qin","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Xiangya Hospital, Central South University","place":["Changsha, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nabeel M.","family":"Abdo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Xiangya Hospital, Central South University","place":["Changsha, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinghuan","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Neurology, Xiangya Hospital, Central South University","place":["Changsha, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazakat","family":"Nurmamat","sequence":"additional","affiliation":[{"name":"Department of Neurology, Xiangya Hospital, Central South University","place":["Changsha, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bi","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Neurology, Xiangya Hospital, Central South University","place":["Changsha, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Neurology, Xiangya Hospital, Central South University","place":["Changsha, China"]},{"name":"Clinical Research Center for Cerebrovascular Disease of Hunan Province","place":["Changsha, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1016\/S1474-4422(07)70036-4","article-title":"Early decompressive surgery in malignant infarction: a pooled analysis","volume":"6","author":"Vahedi","year":"2007","journal-title":"Lancet Neurol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2296","DOI":"10.1056\/nejmoa1503780","article-title":"Thrombectomy within 8 hours after symptom onset in ischemic stroke","volume":"372","author":"Jovin","year":"2015","journal-title":"N Engl J Med"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1723","DOI":"10.1016\/s0140-6736(16)00163-x","article-title":"Endovascular thrombectomy after large-vessel ischemic stroke: a meta-analysis of individual patient data from five randomised trials","volume":"387","author":"Goyal","year":"2016","journal-title":"Lancet"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"708","DOI":"10.1056\/NEJMoa1713973","article-title":"Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging","volume":"378","author":"Albers","year":"2018","journal-title":"N Engl J Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"3450","DOI":"10.1161\/strokeaha.120.033246","article-title":"Cerebral edema in patients with large hemispheric infarct undergoing reperfusion treatment: a HERMES meta-analysis","volume":"52","author":"Ng","year":"2021","journal-title":"Stroke"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"9529","DOI":"10.1038\/s41598-024-60083-w","article-title":"A dynamic nomogram for predicting individual risk of malignant brain edema after endovascular thrombectomy in acute ischemic stroke","volume":"14","author":"Wang","year":"2024","journal-title":"Sci Rep"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"881","DOI":"10.1136\/neurintsurg-2021-017963","article-title":"Predictors of futile recanalization after endovascular treatment in acute ischemic stroke: a meta-analysis","volume":"14","author":"Deng","year":"2022","journal-title":"J Neurointerv Surg"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1186\/s12883-024-03719-8","article-title":"Predictors of futile recanalization after endovascular treatment of acute ischemic stroke: focus on neutrophil-to-lymphocyte ratio as an independent predictor","volume":"24","author":"Wang","year":"2024","journal-title":"BMC Neurol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1254090","DOI":"10.3389\/fneur.2023.1254090","article-title":"Prediction models for post-thrombectomy brain edema in patients with acute ischemic stroke: a systematic review and meta-analysis","volume":"14","author":"Liu","year":"2023","journal-title":"Front Neurol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1007\/s12028-023-01900-4","article-title":"Association between hypoperfusion intensity ratio and postthrombectomy malignant brain edema for acute ischemic stroke","volume":"40","author":"Chen","year":"2024","journal-title":"Neurocrit Care"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"2453635","DOI":"10.1080\/07853890.2025.2453635","article-title":"Neuroimaging predictors of malignant brain edema after thrombectomy in ischemic stroke: a systematic review and meta-analysis","volume":"57","author":"Huang","year":"2025","journal-title":"Ann Med"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1849","DOI":"10.1161\/STROKEAHA.108.534503","article-title":"Temporal and spatial dynamics of cerebral immune cell accumulation in stroke","volume":"40","author":"Gelderblom","year":"2009","journal-title":"Stroke"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1716041","DOI":"10.3389\/fimmu.2025.1716041","article-title":"Immune-mediated blood-brain barrier disruption after ischemic stroke: mechanisms and therapeutic targets","volume":"16","author":"Wang","year":"2025","journal-title":"Front Immunol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1473","DOI":"10.1161\/STROKEAHA.122.036946","article-title":"Neuroinflammation, stroke, blood-brain barrier dysfunction, and imaging modalities","volume":"53","author":"Candelario-Jalil","year":"2022","journal-title":"Stroke"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1152\/physrev.00050.2017","article-title":"Blood-brain barrier: from physiology to disease","volume":"99","author":"Sweeney","year":"2019","journal-title":"Physiol Rev"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1161\/STROKEAHA.120.032130","article-title":"Neutrophil-to-lymphocyte ratio predicts cerebral edema and clinical worsening early after reperfusion therapy in stroke","volume":"52","author":"Ferro","year":"2021","journal-title":"Stroke"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1186\/s12974-018-1359-2","article-title":"Neutrophil-to-lymphocyte ratio predicts intracranial haemorrhage","volume":"15","author":"Pikija","year":"2018","journal-title":"J Neuroinflammation"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1394550","DOI":"10.3389\/fneur.2024.1394550","article-title":"Postoperative neutrophil-to-lymphocyte ratio predicts malignant cerebral edema following endovascular treatment for acute ischemic stroke","volume":"15","author":"Zheng","year":"2024","journal-title":"Front Neurol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"2699","DOI":"10.1161\/STROKEAHA.118.022327","article-title":"Outcomes of endovascular treatment for acute intracranial atherosclerosis-related large vessel occlusion","volume":"49","author":"Baek","year":"2018","journal-title":"Stroke"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"605852","DOI":"10.3389\/fneur.2020.605852","article-title":"Neutrophil count, intracranial atherosclerotic stenosis, and prognosis of ischaemic stroke after endovascular treatment: a mediation analysis","volume":"11","author":"Li","year":"2020","journal-title":"Front Neurol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"2320","DOI":"10.1007\/s11064-023-03923-x","article-title":"Ischemia reperfusion injury induced blood-brain barrier dysfunction and the involved molecular mechanism","volume":"48","author":"Guo","year":"2023","journal-title":"Neurochem Res"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement","volume":"370","author":"Von Elm","year":"2007","journal-title":"Lancet"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"774","DOI":"10.1016\/s0895-4356(01)00341-9","article-title":"Internal validation of predictive models","volume":"54","author":"Steyerberg","year":"2001","journal-title":"J Clin Epidemiol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1136\/jnnp-2014-308327","article-title":"Incidence, causes and predictors of neurological deterioration within 24 h following acute ischemic stroke","volume":"86","author":"Seners","year":"2015","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1245","DOI":"10.1016\/S0140-6736(98)08020-9","article-title":"Randomised double-blind placebo-controlled trial of intravenous alteplase in acute ischaemic stroke (ECASS II)","volume":"352","author":"Hacke","year":"1998","journal-title":"Lancet"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"860","DOI":"10.1016\/S1474-4422(12)70203-X","article-title":"MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2)","volume":"11","author":"Lansberg","year":"2012","journal-title":"Lancet Neurol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1018","DOI":"10.1161\/STROKEAHA.113.003857","article-title":"Hypoperfusion intensity ratio predicts infarct progression and functional outcome","volume":"45","author":"Olivot","year":"2014","journal-title":"Stroke"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1007\/s12028-020-01152-6","article-title":"Hypoperfusion intensity ratio predicts malignant edema and functional outcome in large-vessel occlusive stroke with poor revascularization","volume":"35","author":"Murray","year":"2021","journal-title":"Neurocrit Care"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1056\/NEJMoa1706442","article-title":"Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct","volume":"378","author":"Nogueira","year":"2018","journal-title":"N Engl J Med"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1177\/0272989X06295361","article-title":"Decision curve analysis: a novel method for evaluating prediction models","volume":"26","author":"Vickers","year":"2006","journal-title":"Med Decis Mak"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"268","DOI":"10.7326\/M16-2607","article-title":"Sensitivity analysis in observational research: introducing the E-value","volume":"167","author":"VanderWeele","year":"2017","journal-title":"Ann Intern Med"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"55","DOI":"10.7326\/M14-0697","article-title":"Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD)","volume":"162","author":"Collins","year":"2015","journal-title":"Ann Intern Med"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1276","DOI":"10.1002\/sim.7992","article-title":"Minimum sample size for developing a multivariable prediction model","volume":"38","author":"Riley","year":"2019","journal-title":"Stat Med"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"106550","DOI":"10.1016\/j.jstrokecerebrovasdis.2022.106550","article-title":"Systemic white blood cell count as a biomarker for malignant cerebral edema in large vessel ischemic MCA stroke","volume":"31","author":"Ibrahim","year":"2022","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1159\/000489401","article-title":"Neutrophil-lymphocyte ratio predicts functional and safety outcomes after endovascular treatment for acute ischemic stroke","volume":"45","author":"Duan","year":"2018","journal-title":"Cerebrovasc Dis"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"1496628","DOI":"10.3389\/fneur.2024.1496628","article-title":"Day 3 neutrophil-to-lymphocyte ratio and its derived indices predict 90-day poor outcomes following mechanical thrombectomy in acute ischaemic stroke patients","volume":"15","author":"Gao","year":"2024","journal-title":"Front Neurol"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"e752","DOI":"10.1212\/WNL.0000000000011268","article-title":"Association of interleukin-6 levels and futile reperfusion after mechanical thrombectomy","volume":"96","author":"Mechtouff","year":"2021","journal-title":"Neurology"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"2518","DOI":"10.1161\/STROKEAHA.107.485649","article-title":"Decompressive surgery for treatment of malignant infarction of the middle cerebral artery (DESTINY)","volume":"38","author":"J\u00fcttler","year":"2007","journal-title":"Stroke"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1091","DOI":"10.1056\/NEJMoa1311367","article-title":"Hemicraniectomy in older patients with extensive MCA stroke","volume":"370","author":"J\u00fcttler","year":"2014","journal-title":"N Engl J Med"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1016\/S1474-4422(09)70047-X","article-title":"Surgical decompression for space-occupying cerebral infarction (HAMLET)","volume":"8","author":"Hofmeijer","year":"2009","journal-title":"Lancet Neurol"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1898491\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:14:32Z","timestamp":1788412472000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1898491\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":40,"alternative-id":["10.3389\/fneur.2026.1898491"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1898491","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]},"article-number":"1898491"}}