A204 Differential interleukin-6 dynamics across systemic and cerebrospinal fluid compartment in acute neurovascular injury

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Background/Introduction Despite advances in mechanical thrombectomy for acute ischemic stroke and intensive care management of aneurysmal subarachnoid haemorrhage, outcome prediction remains limited. Interleukin-6 is a key mediator of neuroinflammation, but its compartment specific behaviour across ischemic reperfusion injury and haemorrhagic cerebrospinal fluid inflammation is insufficiently defined. Objective/Purpose To characterise compartment-specific interleukin-6 dynamics in acute ischemic stroke and aneurysmal subarachnoid haemorrhage, representing two common neuroendovascular conditions, and to assess associations with clinical outcome. Methods/Case Description Two prospective cohorts were analysed. The acute ischemic stroke cohort included seventy patients with large-vessel occlusion treated with mechanical thrombectomy. Interleukin-6 was measured in peripheral blood using enzyme-linked immunosorbent assay.The aneurysmal subarachnoid haemorrhage cohort underwent serial cerebrospinal fluid and serum sampling during early (days 1–3), intermediate (days 4–11), and late (days 14–30) phases. Interleukin-6 trajectories, cerebrospinal fluid to serum ratios, and outcome associations were analysed. Receiver operating characteristic analysis assessed prognostic performance. Results/Findings In acute ischemic stroke, higher systemic interleukin-6 levels were associated with greater stroke severity and poorer outcome. Persistently elevated levels were observed in patients with unfavourable outcome, particularly on day 7 (27.5 ± 4.4 vs 15.0 ± 2.1 pg/mL, p< 0.01). In aneurysmal subarachnoid haemorrhage, cerebrospinal fluid interleukin-6 increased from 125.0 ± 61.8 pg/mL (days 1–3) to 373.2 ± 41.4 pg/mL (days 4–11), with sustained elevation thereafter (352.7 ± 108.8 pg/mL, p < 0.01). Higher cerebrospinal fluid interleukin-6 and increased cerebrospinal fluid to serum ratios (24.9–39.6) were associated with unfavourable outcome. Discussion/Conclusions/Learning Points Interleukin-6 demonstrates compartment-dependent dynamics across neurovascular injury. Systemic elevation after mechanical thrombectomy reflects reperfusion-associated inflammation, whereas cerebrospinal fluid interleukin-6 reflects blood brain barrier disruption and sustained central neuroinflammation in aneurysmal subarachnoid haemorrhage. These findings support interleukin-6 as a cross compartment biomarker for risk stratification in acute neurovascular disease.

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