High Neutrophil Extracellular Trap Levels Associated With Lower Functional Independence After Thrombectomy in Stroke

ObjectiveTo investigate the association between neutrophil extracellular traps (NETs) content in retrieved thrombi and 90-day functional outcomes in patients with acute ischemic stroke (AIS) secondary to anterior circulation large vessel occlusion (LVO) undergoing mechanical thrombectomy (MT).MethodsThis retrospective study analyzed data from a prospectively maintained cohort of 129 consecutive AIS patients who underwent MT at West China Hospital between January 2023 and October 2024. Retrieved thrombi were stained for citrullinated histone H3 (CitH3) and myeloperoxidase (MPO) using immunofluorescence, and the percentage of positive area was quantified to represent NETs content (% area). Patients were dichotomized into high-NETs and low-NETs groups based on an optimal cutoff determined by receiver operating characteristic (ROC) curve analysis for predicting poor outcome (modified Rankin Scale [mRS] score 3–6). The primary endpoint was functional independence (mRS 0–2) at 90 days. Multivariable logistic regression was employed to identify independent predictors of outcome.ResultsThe ROC analysis yielded an AUC of 0.644. The optimal cutoff value of defining high NETs content was 2.01%. Among 129 patients (mean age 67.9 years, 48.8% male), 88 (68.2%) were in the high-NETs group. Baseline characteristics were largely comparable, though the high-NETs group had significantly higher admission blood glucose (7.9 vs. 6.7 mmol/L, p = 0.009) and a greater prevalence of atrial fibrillation (65.9% vs. 36.6%, p = 0.002). Despite achieving similarly high rates of successful recanalization (mTICI 2b-3) in both groups (96.6% vs. 97.6%, p = 0.99), patients in the high-NETs group had a significantly lower rate of 90-day functional independence (35.2% vs. 68.3%, p