Ferroptosis biomarkers predict the outcomes of patients with acute ischemic stroke undergoing endovascular thrombectomy

Ferroptosis contributes to ischemic injury in basic experiments, but the roles of ferroptosis in patients with acute ischemic stroke (AIS) who received reperfusion therapy were unclear. This study prospectively enrolled patients with AIS who underwent endovascular thrombectomy (EVT) and non-stroke controls between February 2019 and May 2023. The plasma levels of three ferroptosis biomarkers-heat shock protein 70 (HSP70), ferritin, and acyl-CoA synthetase long-chain family member 4 (ACSL4)-were measured at pre-EVT, immediately post-EVT, and 24 h post-EVT in stroke patients. Outcomes were assessed using modified Rankin Scale (mRS) score and mortality at 3 months. The study enrolled 150 stroke patients and 50 controls. Stroke patients had higher HSP70 levels than controls. Functional independence (mRS score 0-2) was achieved in 42.5% of 134 followed patients, which was inversely associated with ACSL4 level at 24 h (adjusted odds ratio [aOR] 0.12, 95% confidence interval [CI] 0.03-0.56, P = 0.007) in multivariate logistic regression analyses. Morality occurred in 17.2% of these patients, which was inversely associated with pre-EVT HSP70 level (aOR 0.13, 95% CI 0.02-0.98, P = 0.048). In conclusion, ferroptosis was involved in patients with AIS who underwent EVT, and the plasma levels of ACSL4 and HSP70 were significantly associated with clinical outcomes.