Early C-reactive protein dynamics and 90-day functional outcome after complete reperfusion with mechanical thrombectomy

Introduction: The inflammatory response after mechanical thrombectomy may influence clinical outcome. This study evaluated the relationship between the early CRP course and 90-day functional outcome in patients who achieved complete reperfusion with aspiration, and compared CRP levels with those of cases in which a stent retriever was used.Methods: Consecutive adult patients who underwent mechanical thrombectomy between April 2019 and July 2026 were screened retrospectively. The main analysis included patients who achieved final modified Thrombolysis in Cerebral Infarction (mTICI) 3 reperfusion, were treated with aspiration without a stent retriever or Solumbra (additional extracranial/intracranial angioplasty or stenting was allowed), and had CRP measurements at baseline, day 1, and day 3 as well as a 90-day modified Rankin Scale (mRS) score. Patients in whom a stent retriever/Solumbra was used as the first-line or rescue technique, and two patients who underwent decompressive surgery before the day 3 CRP measurement, were excluded from the main analysis. The association between day 3 CRP and unfavorable outcome (mRS 3–6) was assessed with classical and Firth penalized logistic regression. Sensitivity analyses were performed for symptomatic intracranial hemorrhage, decompressive surgery, and additional angioplasty/stenting.Results: Of the 177 patients screened, 65 achieved mTICI 3 reperfusion, and the main analysis comprised 54 patients. Median CRP was 4.47 mg/L at baseline, 12.19 mg/L on day 1, and 29.55 mg/L on day 3 (P<0.001). Forty-three patients (79.6%) reached an mRS of 0–2 at day 90. Day 3 CRP was 18.41 mg/L in the mRS 0–2 group and 107.98 mg/L in the mRS 3–6 group (P<0.001). A one-unit increase in log2(CRP+1) (roughly a doubling of CRP) was associated with increased odds of unfavorable outcome in the adjusted analysis (aOR 2.18; 95% CI 1.15–4.13; Firth aOR 1.87; 95% CI 1.08–3.22). The association persisted after the five patients with symptomatic intracranial hemorrhage were excluded (OR 2.77; 95% CI 1.23–6.24) and in the decompressive surgery sensitivity analyses. No significant CRP difference was found at any time point between the six patients in whom a stent retriever was used and the aspiration group (Table 1 and Figure 1).Discussion/Conclusion: In patients who achieved complete reperfusion with aspiration without a stent retriever, CRP rose markedly over the first three days, and day 3 CRP carried prognostic information for 90-day unfavorable outcome independent of clinical variables.Keywords: