The protective effect of neurointerventional recanalization on the neurovascular unit in acute ischemic stroke and its correlation with serum GFAP and NfL levels

Aim This study aimed to investigate the neuroprotective mechanisms of mechanical thrombectomy (MT) by evaluating its effects on the neurovascular unit (NVU) and correlating these effects with dynamic changes in serum biomarkers in patients with acute ischemic stroke (AIS). Methods A prospective cohort of 128 AIS patients with anterior circulation large vessel occlusion was enrolled. Participants were divided into MT ( n = 68) and intravenous thrombolysis (IVT) ( n = 60) groups. Serum levels of neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP), interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) were measured at baseline (T0), 24 h (T1), and 72 h (T2) post-treatment. Clinical outcomes included recanalization rate (mTICI grade), NIHSS improvement, and 90-day modified Rankin Scale (mRS) score. Results The MT group showed significantly higher recanalization rates (94.1% vs. 36.7%, p < 0.001) and greater neurological improvement (median NIHSS improvement: 8 vs. 4, p < 0.001) compared to the IVT group. Serum NfL, GFAP, IL-1β, and TNF-α levels were markedly lower in the MT group at T1 and T2 (all p < 0.01). Strong correlations were identified between T2 NfL/GFAP levels and clinical outcomes (NIHSS improvement: r = −0.728/−0.663; 90-day mRS: r = 0.705/0.641; all p < 0.001). Conclusion Successful recanalization with MT is associated with mitigated axonal injury, astrocyte activation, and neuroinflammation, findings consistent with better preservation of NVU integrity. Serum NfL and GFAP represent promising biomarkers for predicting stroke prognosis and tailoring therapeutic strategies.