Abstract A023: Endovascular Therapy Rapidly Restores Gut Microbiota Homeostasis and Suppresses Systemic Inflammation in Acute Ischemic Stroke

Background: Disruption of gut microbiota is increasingly recognized as a driver of poor outcomes after acute ischemic stroke (AIS). However, whether revascularization therapy, particularly endovascular thrombectomy (EVT), can restore gut microbiota and modulate the systemic inflammatory response in the acute phase remains to be determined. Methods: 32 patients with AIS due to anterior circulation large vessel occlusion were grouped by whether they received EVT (reperfusion group)(n=17) or standard care without reperfusion (no-reperfusion group)(n=15). Gut microbiota composition, serum bacterial metabolites (trimethylamine N-oxide [TMAO], short-chain fatty acids [SCFAs]), and inflammatory cytokines were assessed at baseline and up to 7 days post-stroke. Neurological outcomes were measured by NIHSS and mRS. Brain infarct volume was determined by MRI. Results: By day 3 after admission, EVT-treated patients exhibited significantly greater gut microbial diversity (ACE index: 132.6 ± 21.1 vs. 103.9 ± 18.6, p=0.05) and higher abundance of Bacteroidota abundance (27.6% vs. 15.3%, p=0.023), as compared to the no-reperfusion group, which had increased Proteobacteria (14.7% vs. 7.8%, p=0.046). TMAO levels remained stable after EVT but rose in the no-reperfusion group (from 1.02×10 3 ± 1.26×10 to 3.23×10 4 ± 4.39×10 4 ng/mL, p