Abstract TP314: Reactive Leukocytosis Following Endovascular Thrombectomy for Large Vessel Occlusion Stroke: Incidence, Predictors, and Impact on Functional Outcomes

Background: Post-stroke systemic inflammation has been proposed as a negative predictor for functional recovery, and anti-inflammatory agents have been explored as potential neuroprotective agents after stroke reperfusion treatments. Yet the incidence and impact of post-stroke inflammation on outcomes after endovascular thrombectomy (EVT) for large vessel occlusion (LVO) stroke are unclear. Methods: A retrospective analysis of LVO stroke patients treated with EVT from 2016 to 2024 was conducted. White blood cell (WBC) counts before and after EVT were collected, and those with post-EVT reactive leukocytosis (PERL) were compared to those without significant WBC elevations. Patients with missing data were excluded. The primary outcome was a 90-day modified Rankin scale (mRS). Patient demographics, time from last known well, stroke severity, infarct burden, comorbidities, and hemorrhagic transformation were also captured. Results: 421 patients were included; mean age was 67.3 years; 51% were male; 123 (29.2%) experienced PERL. PERL patients had lower rates of smoking (35.2% vs. 47.1%, p=0.019), higher rates of antiplatelet use (39.8% vs. 28.9%, p=0.028), and lower pre-EVT WBC counts (mean 8.1 vs. 9.6 thousand cells per microliter, p0.05). PERL was associated with higher rates of hemorrhagic transformation (23.6% vs. 15.4%, p=0.047), larger shifts towards worse mRS (median 3 vs. 2, p