Association of infarct volume with early neurological deterioration in ischemic stroke patients undergoing endovascular treatment

Background Early neurological deterioration (END) remains a frequent and serious complication after endovascular treatment (EVT) for ischemic stroke (IS), even in patients with successful recanalization. The role of infarct volume in predicting END, particularly in the EVT population, has not been fully clarified. Methods This retrospective study included IS patients who underwent EVT between January 2020 and June 2025. Clinical, laboratory, procedural, and imaging data were collected. Infarct volume was quantified using 3D-Slicer. END was defined as an NIHSS increase ≥4 points within 24 h post-EVT. Logistic regression analyses were used to identify independent predictors, and ROC curves were applied to evaluate the predictive performance of infarct volume. Results A total of 682 patients were included, of whom 208 (30.5%) developed END. Multivariate analysis identified systolic blood pressure, atrial fibrillation, triglycerides, the number of EVTs, and infarct volume as independent predictors of END. Infarct volume showed significant predictive value for END (AUC = 0.768), non-hemorrhagic END (AUC = 0.682), and especially hemorrhagic END (AUC = 0.825), with an optimal threshold of 35.5 mL. A nomogram incorporating these independent factors was developed to facilitate individualized risk prediction. Conclusion Infarct volume is an independent predictor of END after EVT, with particularly strong predictive value for hemorrhagic END. Incorporating infarct volume into postoperative risk assessment may improve early identification and management of high-risk patients.