Objective: It is still a major global challenge to reduce the high morbidity and mortality of acute ischemic stroke (AIS) and improve the prognosis of patients. This study aims to investigate the prognostic value of lipoprotein‐associated phospholipase A2 (Lp‐PLA2) combined with lipoprotein(a) (Lp(a)) for long‐term stroke recurrence in patients with AIS.Methods: This study included 580 patients with AIS. Assessment of Lp‐PLA2 and Lp(a) levels was conducted upon patient admission. Continuous monitoring over the long term categorized stroke recurrence as an endpoint. Patients were categorized based on these identified thresholds to compare the risk of stroke recurrence: high Lp‐PLA2 and high Lp(a), high Lp‐PLA2 and low Lp(a), low Lp‐PLA2 and high Lp(a), and low Lp‐PLA2 combined with low Lp(a).Results: Among the 580 participants, 101 individuals (17.41%) experienced stroke recurrence within the 2‐year follow‐up. The majority were male (61.39%), with a median age of 62 years (interquartile range: 55–69.5). Factors independently associated with heightened the risk of recurrence stroke comprised age (hazard ratio [HR], 1.025; p = 0.021), diabetes mellitus (HR, 1.751; p = 0.007), Lp‐PLA2 (HR, 1.004; p < 0.001), and Lp(a) (HR, 1.002; p < 0.001). Noteworthy is that the combination of Lp‐PLA2 and Lp(a) displayed superior predictive efficacy for long‐term stroke recurrence risk in AIS patients compared to individual factors.Conclusion: This investigation underscores the potential advantage of leveraging the combined impact of Lp‐PLA2 in conjunction with Lp(a) as a more precise and cost‐effective predictive tool for the risk of recurrence stroke in patients with AIS.

Objective: Few studies correlated n-terminal pro-brain natriuretic peptide (NT-proBNP) with early neurological deterioration (END) and prognosis of acute ischaemic stroke (AIS) patients with rt-PA intravenous thrombolysis. Therefore this study aimed to investigate the relationship between NT-proBNP and END, and prognosis after intravenous thrombolysis in patients with AIS.Methods: A total of 325 patients with AIS were enrolled. We performed the natural logarithm transformation on the NT-proBNP [ln(NT-proBNP)]. Univariate and multivariate logistic regression analyses were performed to assess the relationship between ln(NT-proBNP) and END, and prognosis and receiver operating characteristic (ROC) curves were used to show the sensitivity and specificity of NT-proBNP.Results: After thrombolysis, among 325 patients with AIS, 43 patients (13.2%) developed END. In addition, three months follow-up showed a poor prognosis in 98 cases (30.2%) and a good prognosis in 227 cases (69.8%). Multivariate logistic regression analysis showed that ln(NT-proBNP) was an independent risk factor for END (OR = 1.450,95%CI:1.072 ~ 1.963,P = 0.016) and poor prognosis at three months follow-up (OR = 1.767, 95%CI: 1.347 ~ 2.317,P < 0.001) respectively. According to ROC curve analysis, ln(NT-proBNP) (AUC 0.735, 95%CI: 0.674 ~0.796,P < 0.001) had a good predictive value for poor prognosis, with a predictive value of 5.12 and sensitivity and specificity of 79.59% and 60.35% respectively. When combined with NIHSS to predict END(AUC 0.718, 95%CI: 0.631 ~ 0.805,P < 0.001) and poor prognosis(AUC 0.780, 95%CI: 0.724 ~ 0.836,P < 0.001), the predictive value of the model is further improved.Conclusion: NT-proBNP is independently associated with END and poor prognosis in patients with AIS following intravenous thrombolysis and has a particular predictive value for END and poor prognosis.

Background: The pathogenesis of ischemic stroke is multifaceted, and growing evidence highlights that mixed etiologies should be considered. This prospective cohort study investigated the relationship between plasma levels of trimethylamine N‐oxide (TMAO), a cardiovascular disease risk factor, and etiologic stroke subtypes. Methods: Plasma TMAO levels were compared in 223 patients, including 95, 73, and 55 patients with large artery atherosclerosis (LAA), cardioembolism (CE), and cardioembolism with culprit artery stenosis (CES), respectively, admitted with acute ischemic stroke complicated by large vessel occlusion and treated with endovascular therapy. At‐admission clinical data and blood samples obtained during intervention were collected. Results: After adjusting for covariates, including age, sex, hypertension, diabetes mellitus, estimated glomerular filtration rate(eGFR), smoking, and alcohol consumption, plasma TMAO levels were highest in the CES group (1.583 μmol/L), followed by the LAA and CE groups (1.064 and 0.583 μmol/L, respectively), with significant differences among the three groups detected (Wald χ ² = 22.877, p < 0.001). By binary logistic regression analysis after adjusting for the same covariates, plasma TMAO level was an independent predictor for distinguishing the CES subtype from the CE subtype (95% CI, 2.062–8.183; p < 0.001), with an area under the curve of 0.778. Conclusion: Plasma TMAO levels, which were highest in patients with stroke due to CES, followed by those with stroke due to LAA and CE, may serve as an independent predictor for distinguishing CE from CES as the stroke etiology.

Purpose: This study aimed to investigate the associations between gut metabolites Trimethylamine N-Oxide (TMAO), the novel platelet-derived inflammatory ratio index neutrophil-to-platelet ratio (NPR), and the prognosis of patients with acute ischemic stroke (AIS) undergoing endovascular therapy (EVT). Methods: This study was a retrospective case–control study. Data were collected from 213 AIS patients who underwent EVT at the Stroke Alliance of the Affiliated Hospital of Xuzhou Medical University between October 2022 and December 2024, including baseline characteristics, laboratory results, and gut-derived metabolite levels from the proximal culprit vessel. Functional outcome was assessed using the modified Rankin scale (mRS) at 3 months after EVT. Based on univariable analysis, a multivariable binary logistic regression model was employed to explore the association of gut-derived TMAO and the platelet-derived inflammatory biomarker NPR with poor functional outcomes. The predictive values of TMAO and NPR, both individually and in combination, were quantitatively compared using receiver operating characteristic (ROC) curves integrated with the DeLong test, continuous net reclassification improvement (cNRI), and integrated discrimination improvement (IDI). Finally, both multiplicative and additive interactions between TMAO and NPR regarding poor functional outcomes were evaluated. Results: A total of 213 eligible patients were divided into the favorable group (mRS ≤ 3, N = 77) and the unfavorable group (mRS > 3, N = 136). After adjusting for confounding factors, multivariable logistic regression analysis revealed that age (OR: 1.065, 95% CI: 1.022–1.109, p = 0.002), baseline National Institutes of Health Stroke Scale (NIHSS) (OR: 1.069, 95% CI: 1.008–1.133, p = 0.025), TMAO (OR: 2.889, 95% CI: 1.563–5.338, p < 0.001), NPR (OR: 1.864, 95% CI: 1.122–3.096, p = 0.016), onset-to-reperfusion time (OTR) (OR: 1.004, 95% CI: 1.002–1.007, p = 0.002), complete recanalization (OR: 0.129, 95% CI: 0.032–0.530, p = 0.004), and hemorrhagic transformation(HT) (OR: 3.271, 95% CI: 1.351–7.918, p = 0.009) were independent predictors of poor functional outcomes. The areas under the curve (AUC) for TMAO, NPR and the combined value of TMAO and NPR in predicting unfavorable outcomes at 3 months after EVT were 0.698, 0.651 and 0.749, respectively. Furthermore, the DeLong test, along with cNRI and IDI analyses, confirmed the significant incremental predictive value of the combined model, and a significant additive interaction between TMAO and NPR was identified. Conclusion: This study revealed that elevated levels of TMAO and NPR are independently associated with poor functional outcomes in AIS patients after EVT. The combined assessment of TMAO and NPR provides incremental value in predicting the prognosis of these patients.