Researchers studied 446 stroke patients who received emergency blood clot removal surgery. They found that patients with lower folate (a B vitamin) and higher homocysteine (an amino acid) levels in their blood were more likely to have poor outcomes 90 days after treatment, even though the surgery successfully removed the clot. By measuring these two blood markers at hospital admission, doctors may be able to better predict which patients need extra care and prevention strategies to improve their recovery.

The Quick Take

  • What they studied: Whether blood levels of folate and homocysteine can predict which stroke patients will have poor recovery even after successful emergency clot removal surgery
  • Who participated: 446 stroke patients (average age 65, about one-third women) who had large blood clots in brain arteries and received emergency endovascular thrombectomy (a minimally invasive surgery to remove clots) between April 2019 and February 2024
  • Key finding: Patients with lower folate levels and higher homocysteine levels at hospital admission were significantly more likely to have poor outcomes at 90 days, even though their surgery was technically successful. About 47% of patients had poor outcomes despite successful clot removal.
  • What it means for you: If you or a loved one has a stroke, doctors may soon be able to use simple blood tests for folate and homocysteine to predict recovery risk and provide more targeted prevention strategies. However, this is preliminary research and needs confirmation in larger studies before changing standard medical practice.

The Research Details

This was a retrospective study, meaning researchers looked back at medical records of stroke patients treated between 2019 and 2024. They collected blood samples taken when patients arrived at the hospital and measured levels of folate, homocysteine, and other blood markers. They then followed patients for 90 days to see who had good versus poor outcomes, defined by a standard disability scale. The researchers used statistical analysis to determine which blood markers were most strongly connected to poor outcomes.

The study focused specifically on patients with large vessel occlusion (major artery blockage) in the front part of the brain who underwent endovascular thrombectomy—a procedure where doctors thread a catheter through blood vessels to physically remove the clot. All patients in the study had successful clot removal, but the researchers wanted to understand why some still had poor recovery.

The researchers built a prediction tool (nomogram) that combines age, stroke severity at admission, time to treatment, blood sugar, folate, and homocysteine levels to estimate individual patient risk.

Understanding why some stroke patients recover poorly despite successful clot removal is crucial for improving outcomes. This study suggests that metabolic factors—specifically folate and homocysteine—may be important. If these blood markers can reliably predict outcomes, doctors could identify high-risk patients early and provide more aggressive prevention strategies, potentially improving long-term recovery.

This study has several strengths: it included a substantial number of patients (446), used objective outcome measures, and performed rigorous statistical analysis. However, it has limitations: it was retrospective (looking back at records rather than following patients forward), conducted at specific hospitals (may not represent all populations), and is described as preliminary research. The findings need to be confirmed in a prospective study (following patients forward) and in different patient populations before being widely adopted in clinical practice.

What the Results Show

Among the 446 stroke patients studied, 210 (47.1%) experienced poor outcomes at 90 days despite successful clot removal. The key finding was that admission blood folate levels and homocysteine levels were independently associated with this poor outcome risk—meaning lower folate and higher homocysteine predicted worse recovery, even after accounting for other factors like age and stroke severity.

When researchers added folate and homocysteine measurements to a standard prediction model based on clinical factors alone, the model’s ability to predict outcomes improved significantly. This suggests these blood markers provide additional useful information beyond what doctors already know from examining patients and measuring stroke severity.

The researchers developed a prediction tool (nomogram) that combines six factors: patient age, stroke severity at admission (National Institute of Health Stroke Scale score), time from procedure start to successful clot removal, blood sugar level, folate level, and homocysteine level. This tool can estimate an individual patient’s risk of poor 90-day outcome.

Interestingly, traditional cholesterol and lipid markers (like LDL and HDL cholesterol) that were measured in the blood were not independent predictors of poor outcomes in this study. This was somewhat surprising because previous research had suggested lipid metabolism might be important. The study suggests that folate and homocysteine metabolism may be more relevant than lipid metabolism for predicting outcomes in this specific situation.

This research builds on the team’s earlier preliminary work that identified two different types of blood clots with different metabolic signatures. The current study confirms that folate metabolism appears particularly important. The findings align with broader research showing that homocysteine is a risk factor for cardiovascular disease, though this is one of the first studies specifically examining its role in predicting stroke recovery after successful clot removal.

The study has several important limitations: First, it’s retrospective, meaning researchers looked back at existing records rather than prospectively following patients, which can introduce bias. Second, it was conducted at specific hospitals in what appears to be a single region, so results may not apply to all populations. Third, the study is described as preliminary, suggesting the findings need confirmation. Fourth, the study doesn’t explain why folate and homocysteine affect stroke recovery—it only shows they’re associated. Finally, the study doesn’t test whether actually treating low folate or high homocysteine would improve outcomes.

The Bottom Line

Based on this preliminary research, doctors may consider measuring folate and homocysteine levels in stroke patients who have undergone successful clot removal to help identify those at higher risk for poor recovery. However, this is not yet standard practice and should not replace current standard care. Patients with low folate might benefit from folate supplementation, and those with high homocysteine might benefit from B vitamins (folate, B6, B12), though this needs to be confirmed in treatment studies. Confidence level: Moderate—this is promising preliminary research that needs confirmation.

This research is most relevant to: (1) stroke patients who have undergone emergency clot removal and their families, (2) neurologists and stroke specialists, (3) hospital systems developing stroke protocols. It’s less immediately relevant to people without stroke history, though understanding stroke risk factors is valuable for prevention. People with high homocysteine or low folate levels should discuss this research with their doctors but shouldn’t make treatment changes based solely on this single study.

The outcomes measured in this study were assessed at 90 days after stroke. If folate and homocysteine treatment were to be implemented, benefits would likely be evaluated over weeks to months, though the study doesn’t address treatment timelines.

Want to Apply This Research?

  • For stroke survivors or those at risk: Track folate intake (leafy greens, legumes, fortified grains) and homocysteine-related B vitamin intake (B6, B12, folate) daily. Log servings of folate-rich foods and any B vitamin supplements taken. Target: 400 mcg folate daily from food or supplements.
  • Users could set a daily reminder to consume folate-rich foods (spinach, broccoli, lentils, chickpeas, fortified cereals) and track intake in the app. For those with elevated homocysteine, the app could remind users to take B-complex vitamins as recommended by their doctor and log compliance.
  • Users should work with their doctor to get folate and homocysteine levels checked periodically (typically annually or as recommended). Log these lab results in the app to track trends over time. Also track any stroke-related symptoms or recovery milestones. Share this data with healthcare providers to inform personalized prevention strategies.

This research is preliminary and has not yet changed standard medical practice. It should not be used to self-diagnose or self-treat. If you have had a stroke or are at risk for stroke, discuss these findings with your neurologist or primary care doctor before making any changes to your treatment or supplementation. Do not start taking folate or B vitamin supplements without consulting your healthcare provider, as they may interact with other medications. This study shows association, not causation—it does not prove that treating low folate or high homocysteine will improve stroke outcomes. Always follow your doctor’s recommendations for stroke prevention and recovery.