Residual cholesterol as a predictor of early functional outcome after endovascular treatment for acute large-vessel occlusion ischemic stroke

Background Residual cholesterol, an important marker of lipid metabolism, has been increasingly used in recent years as a monitoring indicator for insulin resistance and for prognosis surveillance after major cardiovascular interventions. However, evidence regarding its utility for functional prognostication in acute occlusive ischemic stroke—particularly among patients undergoing endovascular therapy—remains limited. This study aimed to evaluate whether residual cholesterol can predict functional outcomes after endovascular treatment. Methods We retrospectively analyzed 254 consecutive patients with acute ischemic stroke who underwent endovascular therapy at Beijing Chaoyang Hospital, Capital Medical University, between October 2022 and October 2023. Patients were divided into two groups according to functional outcome. Baseline clinical characteristics and preprocedural biochemical indices were collected to calculate residual cholesterol, and correlation analyses were performed. Independent prognostic factors were identified using logistic regression, and receiver operating characteristic (ROC) curves were generated to assess the predictive performance of residual cholesterol. Results Residual cholesterol (RC) was significantly higher in the poor-outcome group than in the good-outcome group (0.86 [0.49, 1.27] vs 0.64 [0.43, 1.12], p = 0.033). After adjustment in multivariable logistic regression, RC remained an independent predictor of 90-day functional independence after EVT (OR, 1.911; 95% CI, 1.039–3.585; p = 0.040). Conclusion RC has important value in predicting 3-month functional outcomes in patients with AIS due to large-vessel occlusion undergoing EVT, and it improves the predictive performance of models based solely on clinical variables.