[Factors influencing hemorrhagic transformation after mechanical thrombectomy in patients with acute ischemic stroke patients].

Authors

Fan Feng, Yuhui Chen, Jiawen Yin, Lei Xu, Jiachun Liu, Jinyu Qiao, Tao Gong

Published in

Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences. Volume 51. Issue 5. Pages 870-880. May 28, 2026.

Abstract

Patients with acute ischemic stroke remain at risk of hemorrhagic transformation after mechanical thrombectomy, which may lead to neurological deterioration and adversely affect clinical outcomes. Early identification of related risk factors is therefore important for optimizing perioperative management. This study aimed to investigate the clinical factors associated with hemorrhagic transformation (HT) after mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS), and to further evaluate the value of these factors in combination for predicting the risk of HT after MT, thereby providing a reference for early identification of high-risk patients, optimization of perioperative management, and development of individualized follow-up strategies.
This was a single-center, prospective, observational cohort study. A total of 268 patients with AIS who underwent MT and had complete clinical data at the Stroke Center of Beijing Hospital between May 2020 and December 2024 were consecutively enrolled. All patients met the diagnostic criteria for AIS and the indications for vascular recanalization therapy. Patients were excluded if they had a pre-stroke Modified Rankin Scale score ≥3, hemorrhagic disorders or a clear bleeding tendency, onset-to-treatment time ≥24 h, large-area cerebral infarction, severe cardiac, pulmonary, hepatic, or renal disease, end-stage malignant tumors, loss to follow-up, or unwillingness to participate in follow-up. HT was determined according to cranial computed tomography (CT) or magnetic resonance imaging (MRI) findings within 14 days after MT, and the patients were divided into an HT group and a non-HT group. Data were collected using standardized case report forms, including demographic characteristics, previous stroke risk factors, use of antiplatelet drugs, unhealthy lifestyle factors, onset-to-thrombectomy time, baseline National Institutes of Health Stroke Scale (NIHSS) score, preoperative blood pressure, emergency laboratory test results, stroke etiological classification, infarct location, intravenous thrombolysis, thrombectomy method, and vascular recanalization status. The t test, Mann-Whitney U test, and chi-square test were used to compare clinical characteristics between the two groups. Variables with statistically significant differences in univariate analysis, together with variables considered clinically relevant or previously reported to be associated with HT, were included in multivariate Logistic regression analysis to identify independent factors associated with HT after MT in AIS patients. Individual predicted probabilities were calculated based on the final Logistic regression model, and receiver operating characteristic (ROC) curve analysis was performed. The area under the curve (AUC) was used to evaluate the discriminative ability of the model for HT after MT.
A total of 268 AIS patients were included in this study, including 156 males and 112 females, with a mean age of (72.6±12.9) years. HT occurred in 92 patients after MT, with an incidence of 34.3%. Among them, 29 patients had hemorrhagic infarction type 1 (HI-1), 24 had hemorrhagic infarction type 2 (HI-2), 16 had parenchymal hematoma type 1 (PH-1), and 23 had parenchymal hematoma type 2 (PH-2). Symptomatic intracranial hemorrhage (sICH) occurred in 15 patients, with an incidence of 5.6%. Compared with the non-HT group, the HT group had a higher proportion of patients with a history of coronary heart disease, a lower proportion of patients with a history of stroke, higher baseline NIHSS scores, a higher proportion of patients with NIHSS score ≥12, a lower proportion of posterior circulation infarction, and a lower rate of favorable outcome at 3 months (all P<0.05). In terms of laboratory indicators, platelet count and fibrinogen level were lower in the HT group than in the non-HT group (both P<0.05). There were no statistically significant differences between the 2 groups in age, sex, history of hypertension, history of diabetes mellitus, atrial fibrillation, hyperlipidemia, smoking, alcohol consumption, use of antiplatelet drugs, onset-to-thrombectomy time, trial of Org 10172 in acute stroke treatment (TOAST) classification, intravenous thrombolysis before MT, stent retriever thrombectomy, aspiration thrombectomy, vascular recanalization status, or mortality (all P>0.05). Multivariate Logistic regression analysis showed that baseline NIHSS score ≥12 [odds ratio (OR)=2.271, 95% confidence interval (CI) 1.266 to 4.076, P<0.01] and history of coronary heart disease (OR=2.144, 95% CI 1.141 to 4.026, P<0.05) were independent risk factors for HT after MT in AIS patients. Patients with NIHSS score ≥12 had an increased risk of HT, and those with a history of coronary heart disease also had a significantly higher risk of HT. A higher fibrinogen level (OR=0.651, 95% CI 0.467 to 0.909, P<0.05) was independently associated with a lower risk of HT. After further adjustment for the use of antiplatelet drugs, history of coronary heart disease remained independently associated with HT, whereas antiplatelet drug use itself showed no independent association. The multivariate Logistic regression prediction model constructed using NIHSS score ≥12, history of coronary heart disease, fibrinogen level, and antiplatelet drug use had an AUC of 0.680.
The incidence of HT after MT is relatively high in patients with AIS. A baseline NIHSS score ≥12 and a history of coronary heart disease were identified as independent risk factors for HT, whereas a higher fibrinogen level was an independent protective factor. The predictive model developed in this study may facilitate early identification of HT risk; however, further optimization through the incorporation of additional imaging and perioperative variables, as well as validation in multicenter studies, is warranted.

PMID:
42565565
Bibliographic data and abstract were imported from PubMed on 07 Aug 2026.

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