NLR–FAR Index as a superior predictor of 30-day functional outcome after endovascular thrombectomy in acute ischemic stroke

Objective: To determine whether the neutrophil-to-lymphocyte ratio-fibrinogen-to-albumin ratio (NLR-FAR) Index predicts long-term prognosis in acute ischemic stroke patients undergoing endovascular thrombectomy (EVT). Introduction: Systemic inflammatory imbalance contributes to ischemic brain injury, but the combined effect of NLR and FAR on EVT outcomes has remained unclear. Methods: We retrospectively analyzed patients treated with EVT. A composite inflammatory-coagulation index, designated as the NLR-FAR Index, was defined as the product of NLR and FAR. The primary endpoint was 30-day functional outcome defined by the modified Rankin Scale (mRS), with poor outcome as mRS ≥3. Logistic regression and restricted cubic spline analyses were used to assess associations. Results: = 1.910, 95% CI: 1.079-3.384). Restrictive cubic spline analysis shows that when the NLR-FAR index exceeds the threshold of 0.62, the risk of adverse outcomes at 30 days begins to significantly increase. Conclusion: The NLR-FAR Index independently predicts functional outcomes after EVT and outperforms NLR or FAR alone. This accessible biomarker may aid early risk stratification and individualized management in acute ischemic stroke.