Relationship of CT-related parameters with hemorrhagic transformation and prognosis after mechanical thrombectomy in patients with acute ischemic stroke

SUN Teng; QIN Ruwei; SUN Zhilei; YAN Jiulong; SHEN Likui

doi:10.3969/j.issn.1009-0126.2026.02.019

Abstract：Objective To investigate the relationship of CT scanning and CT perfusion imaging parameters with hemorrhagic transformation(HT)and prognosis after mechanical thrombectomy in patients suffering from AIS-LVO.Methods A total of 178 AIS-LVO patients admitted to the Department of Intervention of the First Affiliated Hospital of Soochow University from January 2022 to November 2024 were recruited,and based on the occurrence of HT within 24 h postoperatively,they were divided into an HT group(n=25)and a non-HT group(n=153).All patients underwent plain CT and CT perfusion examinations,and relevant imaging data were collected,including ASPECTS,hyperdense middle cerebral artery sign(HMCAS),CBF,CBV,mean transit time(MTT),and permeability surface(PS).Multivariate logistic regression analysis was performed to identify the influencing factors for HT occurrence and poor prognosis.ROC curves were plotted again to evaluate the predictive value of CT-related parameters for poor prognosis.Results The HT group exhibited significantly higher NIHSS scores,HMCAS,MTT,and PS at admission,while obviously lower ASPECTS,CBV and CBF when compared to the non-HT group(P<0.01).Multiple logistic regression analysis showed that baseline NIHSS score,baseline ASPECTS,HMCAS,CBF,and MTT were independent predictors of HT occurrence after mechanical thrombectomy in the AIS-LVO patients(P<0.05).Hypertension,baseline NIHSS score,baseline ASPECTS,HMCAS,CBF,MTT,and PS were independent predictors of poor prognosis after mechanical thrombectomy in the AIS-LVO patients(P<0.05).ROC curve analysis suggested that the AUC value of combined plain CT and CT perfusion parameters in predicting poor prognosis after mechanical thrombectomy in AIS-LVO patients was 0.960,with a sensitivity of 0.934 and a specificity of 0.863.Conclusion ASPECTS,HMCAS,CBF and MTT are related to HT and prognosis after mechanical thrombectomy in AIS-LVO patients.They can serve as auxiliary indicators for the prediction of HT and poor prognosis for AIS-LVO after mechanical thrombectomy.