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Research Article: Latent class analysis identifies three biologically distinct phenotypes among patients undergoing endovascular thrombectomy: a derivation and temporal validation study

Date Published: 2026-10-15

Abstract:
Despite successful vascular recanalization, approximately half of patients undergoing endovascular thrombectomy (EVT) fail to achieve functional independence at 3?months. The biological determinants of this heterogeneity remain poorly characterized. Latent class analysis (LCA) was applied to 825 consecutive EVT-treated patients (development cohort, January 2021–December 2024) using 12 routine post-procedural clinical and laboratory indicators. Phenotype associations with favorable 3-month outcome (modified Rankin Scale 0–2) were assessed using multivariable logistic regression. Reproducibility was evaluated in an independent temporal validation cohort ( n =?211). LCA identified three phenotypes. The Low-burden phenotype (Class 1, 44.4%) had the lowest inflammatory and coagulatory burden and achieved favorable outcome in 70.8% of patients. The Metabolic phenotype (Class 2, 42.7%), characterized by hyperglycemia and elevated neutrophil-to-lymphocyte ratio, had a favorable outcome rate of 44.9% and symptomatic intracranial hemorrhage (sICH) rate of 7.1%. The hypercoagulable phenotype (Class 3, 13.0%), defined by markedly elevated D-dimer and atrial fibrillation, had a favorable outcome rate of 40.2% and sICH rate of 8.4%. After multivariable adjustment, both Class 2 (OR 0.49, 95% CI 0.35–0.69) and Class 3 (OR 0.41, 95% CI 0.25–0.67) were independently associated with unfavorable outcome (both p <?0.001). Class distribution and outcome associations were reproduced in the validation cohort. LCA identified three biologically distinct phenotypes among EVT-treated patients with divergent functional outcomes. Multicenter prospective validation is needed before these findings can inform clinical practice.

Introduction:
Despite successful vascular recanalization, approximately half of patients undergoing endovascular thrombectomy (EVT) fail to achieve functional independence at 3?months. The biological determinants of this heterogeneity remain poorly characterized.

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