Objective: Large cohort studies provided evidence that elevated remnant cholesterol (RC) was an important risk factor for ischemic stroke. However, the association between high RC and clinical outcomes in acute ischemic stroke (AIS) individuals was still undetermined. Methods: This retrospective study enrolled 165 AIS patients undergoing mechanical thrombectomy in one tertiary stroke center. We divided patients into two groups based on the median of their RC levels (0.49 mmol/L). The modified Rankin Scale (mRS) was used to evaluate the primary outcome 90 days after the onset of symptoms. The mRS scores ≤ 2 and ≤ 1 at 90 days were deemed as favorable and excellent outcomes, respectively. Results: In the overall AIS patients undergoing mechanical thrombectomy, there was no obvious distinction between the high and low RC group at 90-day favorable outcome (41.0% vs. 47.1%, P = 0.431) or excellent outcome (23.1% vs. 31.0%, P = 0.252). In the subgroup analysis stratified by stroke etiology, non-large artery atherosclerosis (non-LAA) stroke patients yielded with less favorable or excellent prognosis in the high RC group (26.8% vs. 46.8%, adjusted OR = 0.31, 95%CI: 0.11–0.85, P = 0.023; or 12.2% vs. 29.0%, adjusted OR = 0.18, 95%CI: 0.04–0.80, P = 0.024, respectively.). Post hoc power analyses indicated that the power was sufficient for favorable outcome (80.38%) and excellent outcome (88.72%) in non-LAA stroke patients. Additionally, RC can enhance the risk prediction value of a poor outcome (mRS scores 3–6) based on traditional risk indicators (including age, initial NIHSS score, operative duration, and neutrophil-to-lymphocyte ratio) for non-LAA stroke patients (AUC = 0.86, 95%CI: 0.79–0.94, P < 0.001). Conclusion: In AIS patients undergoing mechanical thrombectomy, elevated RC was independently related to poor outcome for non-LAA stroke patients, but not to short-term prognosis of LAA stroke patients.

目的：大型队列研究提供的证据表明残余胆固醇（RC）升高是缺血性中风的重要危险因素。然而，高 RC 与急性缺血性卒中 (AIS) 个体临床结果之间的关联仍不确定。方法：这项回顾性研究纳入了 165 名在一个三级卒中中心接受机械血栓切除术的 AIS 患者。我们根据患者 RC 水平的中位数（0.49 mmol/L）将患者分为两组。使用改良Rankin量表（mRS）评估症状出现90天后的主要结果。90天时mRS评分≤2和≤1分别被视为良好和优秀的结果。结果：在接受机械血栓切除术的总体 AIS 患者中，高 RC 组和低 RC 组在 90 天的良好结局（41.0% vs. 47.1%，P = 0.431）或优异结局（23.1% vs. 31.0）时没有明显区别。 ％，P = 0.252）。在按卒中病因分层的亚组分析中，高 RC 组中非大动脉粥样硬化 (non-LAA) 卒中患者的预后较差或极好（26.8% vs. 46.8%，调整后 OR = 0.31，95%CI： 0.11–0.85，P = 0.023；或 12.2% 与 29.0%，调整后 OR = 0.18，95%CI：0.04–0.80，P = 0.024。）。事后功效分析表明，功效足以使非左心耳卒中患者获得良好的结果 (80.38%) 和优异的结果 (88.72%)。此外，RC 可以提高非 LAA 卒中患者基于传统风险指标（包括年龄、初始 NIHSS 评分、手术持续时间和中性粒细胞与淋巴细胞比率）的不良结局（mRS 评分 3-6）的风险预测值（AUC = 0.86，95% CI：0.79–0.94，P < 0.001）。结论：在接受机械血栓切除术的 AIS 患者中，RC 升高与非左心耳卒中患者的不良预后独立相关，但与左心耳卒中患者的短期预后无关。