Peri-procedural and early body temperature trajectories after endovascular thrombectomy and clinical outcomes in intensive care unit patients with acute ischemic stroke: a retrospective cohort study

Background Body temperature after endovascular thrombectomy (EVT) is often summarized by single measurements or fever thresholds, which do not capture temporal patterns. We examined peri-procedural and early post-EVT temperature trajectories and their associations with 90-day outcomes in ICU patients with acute ischemic stroke. Methods This single-center retrospective cohort included 237 ICU patients undergoing EVT. Axillary temperature was recorded at nine prespecified time points from EVT initiation through 72 h. Patient-specific cubic curves were clustered using Gaussian mixture models. The primary outcome was 90-day unfavorable functional outcome (modified Rankin Scale 3–6); secondary outcomes included 90-day mortality and post-stroke seizures. Multivariable models adjusted for prespecified baseline and procedural covariates. Results Four trajectories were identified: stable normothermia ( n = 89), early transient temperature rise ( n = 49), delayed fever ( n = 32), and persistent hyperthermia ( n = 67). Unfavorable functional outcome occurred in 143 patients (60.3%) and 60 (25.3%) died by 90 days. The global trajectory-class test was significant for mortality ( p = 0.019) but not for unfavorable functional outcome ( p = 0.088) or post-exposure seizure ( p = 0.126). Compared with stable normothermia, persistent hyperthermia was associated with higher 90-day mortality (adjusted OR 4.51, 95% CI 1.65–12.34). This association was attenuated after adjustment for early antipyretic use (adjusted OR 3.02, 95% CI 0.98–9.32; global p = 0.241) and after exclusion of patients with infection within 72 h (adjusted OR 3.92, 95% CI 1.18–12.97; global p = 0.066). Seizure analyses were exploratory. Conclusion Greater temperature exposure was associated with worse outcomes, consistent with previous work on post-stroke fever. Persistent hyperthermia was associated with mortality in the primary analysis, but the association weakened in key sensitivity analyses. Trajectory classification did not establish added prognostic value over simpler temperature metrics and should be considered exploratory rather than a new prognostic tool.