Prognostic value of serial IL-6 and NSE measurements in acute ischemic stroke patients undergoing mechanical thrombectomy

Despite major advances in acute stroke therapy, particularly mechanical thrombectomy (MT) for large-vessel occlusion, predicting outcomes in acute ischemic stroke (AIS) remains challenging. Secondary injury mechanisms such as neuroinflammation and neuronal damage contribute substantially to poor recovery, yet are insufficiently captured by clinical and imaging models alone. Interleukin-6 (IL-6) and neuron-specific enolase (NSE) represent complementary biomarkers of these processes, but their combined and serial prognostic value in MT-treated patients has not been fully defined. To evaluate the prognostic significance of serial plasma IL-6 and NSE measurements for predicting stroke severity, complications, and functional recovery in AIS patients undergoing MT. In this prospective study, 70 patients with AIS due to large-vessel occlusion treated with MT were enrolled. IL-6 and NSE were measured on Day1 and Days7–10. Associations with neurological severity (NIHSS), hemorrhagic transformation, and functional outcome (mRS) were analyzed. Multivariate linear regression and hierarchical logistic regression models were used to assess the incremental prognostic value of biomarkers beyond established clinical predictors. Higher IL-6 and NSE levels were associated with greater neurological severity, unfavorable functional outcomes, and hemorrhagic transformation at both time points. NSE showed moderate correlations with NIHSS and mRS (R 2 = 0.19–0.23). In multivariable models, IL-6 and NIHSS independently predicted mRS at discharge. Serial IL-6 measurements significantly improved prediction of unfavorable outcome beyond NIHSS alone, increasing the AUC from 0.847 to 0.914 in the fully adjusted model (ΔAUC = +0.067, p < 0.001), whereas NSE provided complementary biological information on neuronal injury. Serial assessment of IL-6 and NSE offers clinically meaningful insight into inflammatory and neurodestructive mechanisms that influence recovery after AIS treated with MT. In particular, dynamic IL-6 measurements provide measurable incremental prognostic value beyond baseline neurological severity, supporting their integration into multimodal risk-stratification strategies for personalized post-stroke management. • Serial interleukin-6 and neuron-specific enolase levels reflect inflammatory and neurodestructive pathways after mechanical thrombectomy. • Both biomarkers correlate with neurological severity, hemorrhagic transformation, and early functional outcome. • Multivariable and hierarchical modeling demonstrate that serial IL-6 dynamics add measurable prognostic value beyond baseline NIHSS. • Incorporating biomarker trajectories improves risk stratification for unfavorable outcomes after acute ischemic stroke. • A practical, hypothesis-generating clinical framework is proposed to guide monitoring intensity and post-stroke management.