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CC BY 4.0 · Arq Neuropsiquiatr 2025; 83(10): s00451812301
DOI: 10.1055/s-0045-1812301
Original Article

Prognostic biomarkers in ischemic stroke treated with mechanical thrombectomy: a systematic review

Authors

  • Rodrigo Fellipe Rodrigues 

    1   Universidade Federal de São Paulo, Programa de Pós-Graduação em Biologia Estrutural e Funcional, São Paulo, SP, Brazil.
    2   University of Toronto, Department of Neurosurgery, Division of Interventional Neuroradiology, St. Michael's Hospital, Toronto, ON, Canada.

  • Raquel Cristina Trovo Hidalgo 

    3   Faculdade de Medicina de São José do Rio Preto, Departamento de Neurorradiologia Intervencionista, São José do Rio Preto, SP, Brazil.

  • Savio Batista 

    4   Emory University, Department of Neurology, Atlanta, GA, USA.

  • Júlia Belone Lopes 

    5   Faculdade de Medicina de São José do Rio Preto, Departamento de Oncologia Clínica, São José do Rio Preto, SP, Brazil.
    6   University of Toronto, Department of Medical Oncology, Sunnybrook Health Science Centre, Toronto, ON, Canada.

  • Gabriel Paulo Mantovani 

    7   Hospital de Clínicas de Porto Alegre, Departamento de Neurologia, Porto Alegre, RS, Brazil.

  • Pedro Henrique Matos Oliveira 

    8   Escola Bahiana de Medicina e Saúde Pública, Departamento de Medicina, Salvador, BA, Brazil.

  • André Nishizima 

    8   Escola Bahiana de Medicina e Saúde Pública, Departamento de Medicina, Salvador, BA, Brazil.

  • Anderson Silva Corin 

    9   Universidade Federal de Pelotas, Departamento de Medicina, Pelotas, RS, Brazil.

  • Lucas Macedo 

    10   Universidade de Brasília, Departamento de Medicina, Brasília, DF, Brazil.

  • Mariana Letícia de Bastos Maximiano 

    11   Universidade Federal Fluminense, Departamento de Medicina, Rio de Janeiro, RJ, Brazil.

  • Pedro Lucas Machado Magalhães 

    12   Instituto de Educação Médica, Departamento de Medicina, Angra dos Reis, RJ, Brazil.

  • Julia Camargo Ricci 

    13   Universidade Estadual Paulista "Júlio de Mesquita Filho", Instituto de Biociências, Letras e Ciências Exatas, São José do Rio Preto, SP, Brazil.

  • Sonia Maria Oliani 

    1   Universidade Federal de São Paulo, Programa de Pós-Graduação em Biologia Estrutural e Funcional, São Paulo, SP, Brazil.
    13   Universidade Estadual Paulista "Júlio de Mesquita Filho", Instituto de Biociências, Letras e Ciências Exatas, São José do Rio Preto, SP, Brazil.
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Abstract

Background

Mechanical thrombectomy (MT) is a key therapy for acute ischemic stroke (AIS), improving survival and functional outcomes. However, the variability in results highlights the need for predictive markers to refine patient selection. Biomarkers reflecting inflammation and metabolic stress are gaining recognition for their role in AIS and MT outcomes.

Objective

To systematically review and synthesize the evidence on biomarkers associated with clinical outcomes in AIS patients undergoing MT. Specific aims include evaluating their relationship with functional recovery (mRS), mortality, infarct volume, hemorrhagic transformation, and complications such as malignant brain edema (MBE) and delayed cerebral ischemia (DCI).

Methods

A systematic review of the literature was conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to identify studies evaluating biomarkers in MT. The PubMed and Embase databases were searched using the following terms: (Marker OR biomarker*) AND (Mechanical Thrombectomy OR endovascular) AND Stroke.

Results

Of 2,834 articles identified, 86 met inclusion criteria. Several biomarkers, such as C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), adenosine deaminase (ADA), neuron-specific enolase (NSE), and matrix metalloproteinase-9 (MMP-9), were consistently associated with worse functional outcomes, increased mortality, and higher risk of complications including hemorrhagic transformation and MBE.

Conclusion

Multiple biomarkers demonstrate prognostic value in AIS patients undergoing MT. These findings may support risk stratification and individualized care, though further prospective studies are needed to integrate these biomarkers into the clinical practice.

Keywords

Ischemic Stroke - Thrombectomy - Biomarkers - Treatment Outcome

Data Availability Statement

This study is a systematic review, and all data analyzed were extracted from previously published studies. The datasets supporting the findings of this review are available in the original articles cited in the manuscript. No new data were collected specifically for this study.


Authors' Contributions

Conceptualization: RFR, RCTH, SB, JBL, GPM, PHMO, AN, ASC, LM, MLBM, JCR, PLMM, SMO; Data curation: RFR, RCTH, SB, PHMO, AN, ASC, LM, MLBM, PLMM, SMO; Formal analysis: RFR, RCTH, SB, JBL, GPM, PHMO, AN, ASC, LM, MLBM, PLMM, SMO; Investigation: RFR, SB, SMO; Methodology: RFR, RCTH, SB, JBL, GPM, PHMO, AN, ASC, LM, MLBM, PLMM, SMO; Project administration: RFR, RCTH, SB, SMO; Resources: RFR, SMO; Software: RFR, SB, SMO; Supervision: RFR, RCTH, SB, SMO; Validation: RFR, RCTH, SB, JBL, GPM, MLBM, JCR, PLMM, SMO; Visualization: RFR, RCTH, SB, JBL, GPM, PHMO, AN, ASC, LM, MLBM, JCR, PLMM, SMO; Writing - original draft: RFR, RCTH, SB, JBL, GPM, PHMO, AN, ASC, LM, MLBM, JCR, PLMM, SMO.


Editor-in-Chief: Ayrton Roberto Massaro (ORCID: 0000-0002-0487-5299).


Associate Editor: Octávio Marques Pontes Neto (ORCID: 0000-0003-0317-843X).




Publication History

Received: 06 April 2025

Accepted: 27 July 2025

Article published online:
31 October 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Rodrigo Fellipe Rodrigues, Raquel Cristina Trovo Hidalgo, Savio Batista, Júlia Belone Lopes, Gabriel Paulo Mantovani, Pedro Henrique Matos Oliveira, André Nishizima, Anderson Silva Corin, Lucas Macedo, Mariana Letícia de Bastos Maximiano, Pedro Lucas Machado Magalhães, Julia Camargo Ricci, Sonia Maria Oliani. Prognostic biomarkers in ischemic stroke treated with mechanical thrombectomy: a systematic review. Arq Neuropsiquiatr 2025; 83: s00451812301.
DOI: 10.1055/s-0045-1812301