ABSTRACT NUMBER: ESOC2026A2128 SNFL AS AN EARLY PREDICTOR OF OUTCOME AFTER ENDOVASCULAR STROKE THERAPY

Abstract Background and aims Early outcome prognostication after mechanical thrombectomy (MT) for large vessel occlusion (LVO) stroke remains challenging. Serum neurofilament light chain (sNfL) reflects neuroaxonal damage and may improve early prediction of clinical outcomes. Methods In this prospective, single-center observational study, we analyzed data from 180 ischemic stroke patients with LVO treated by endovascular therapy enrolled in the Gutenberg Stroke Study. Serum sNfL concentrations were measured at baseline, 24 h, 72 h, and 120 h after MT using single molecule array (SiMoA) technology. Functional outcome (modified Rankin Scale, mRS) and mortality were assessed at 90 days. Cerebral atrophy scores and white matter lesion burden were evaluated on admission imaging. Prognostic accuracy was analyzed using receiver operating characteristic (ROC) curves and multivariable logistic regression models. Results sNfL levels were significantly higher in patients with poor functional outcome (mRS > 2) and in those who died within 90 days across all time points, with increasing predictive accuracy over time. sNfL measured at 24 hours (sNfL-24h) showed acceptable prognostic accuracy for functional outcome (AUC = 0.776) and mortality (AUC = 0.681). A cut-off of 59.3 pg/mL predicted good functional outcome with 71.3% sensitivity and 69.8% specificity. In multivariable analyses adjusting for clinical, imaging, and vascular risk factors, sNfL-24h remained an independent predictor of poor functional outcome. Adding sNfL-24h improved prediction of functional outcome but not mortality. Conclusions sNfL-24h provides early and clinically meaningful prognostic information on 90-day functional outcome after MT and complements established predictors in LVO stroke patients. Conflict of interest A.C.: nothing to disclose, L.W.: nothing to disclose, M.H.: nothing to disclose, L.B.: nothing to disclose, T.U.: personal fees from Merck Serono and Pfizer, grants from Else Kröner-Fresenius Stiftung