Low blood flow ratio is associated with hemorrhagic transformation secondary to mechanical thrombectomy in patients with acute ischemic stroke

IF 3 3区医学 Q2 CLINICAL NEUROLOGY

Journal of Neuroradiology Pub Date : 2024-04-04 DOI:10.1016/j.neurad.2024.03.003

Lufei Feng , Mengying Yu , Mo Zheng , Wangle Huang , Fei Yao , Chaomin Qiu , Ru Lin , Ying Zhou , Haoyu Wu , Guoquan Cao , Dexing Kong , Yunjun Yang , Haoli Xu

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Abstract

Background and purpose

A significant decrease of cerebral blood flow (CBF) is a risk factor for hemorrhagic transformation (HT) in acute ischemic stroke (AIS). This study aimed to ascertain whether the ratio of different CBF thresholds derived from computed tomography perfusion (CTP) is an independent risk factor for HT after mechanical thrombectomy (MT).

Methods

A retrospective single center cohort study was conducted on patients with AIS undergoing MT at the First Affiliated Hospital of Wenzhou Medical University from August 2018 to December 2023. The perfusion parameters before thrombectomy were obtained according to CTP automatic processing software. The low blood flow ratio (LFR) was defined as the ratio of brain volume with relative CBF <20 % over volume with relative CBF <30 %. HT was evaluated on the follow-up CT images. Binary logistic regression was used to analyze the correlation between parameters that differ between the two groups with regards to HT occurrence. The predictive efficacy was assessed utilizing the receiver operating characteristic curve.

Results

In total, 243 patients met the inclusion criteria. During the follow-up, 46.5 % of the patients (113/243) developed HT. Compared with the Non-HT group, the HT group had a higher LFR (0.47 (0.34–0.65) vs. 0.32 (0.07–0.56); P < 0.001). According to the binary logistic regression analysis, the LFR (aOR: 6.737; 95 % CI: 1.994–22.758; P = 0.002), Hypertension history (aOR: 2.231; 95 % CI: 1.201–4.142; P = 0.011), plasma FIB levels before MT (aOR: 0.641; 95 % CI: 0.456–0.902; P = 0.011), and the mismatch ratio (aOR: 0.990; 95 % CI: 0.980–0.999; P = 0.030) were independently associated with HT secondary to MT. The area under the curve of the regression model for predicting HT was 0.741.

Conclusion

LFR, a ratio quantified via CTP, demonstrates potential as an independent risk factor of HT secondary to MT.

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低血流比与急性缺血性脑卒中患者继发于机械性血栓切除术的出血性转变有关

脑血流（CBF）明显减少是急性缺血性卒中（AIS）出血性转化（HT）的风险因素。本研究旨在确定计算机断层扫描灌注（CTP）得出的不同CBF阈值的比值是否是机械性血栓切除术（MT）后出血转化的独立风险因素。2018年8月至2023年12月，温州医科大学附属第一医院对接受MT的AIS患者进行了一项回顾性单中心队列研究。血栓切除术前的灌注参数根据CTP自动处理软件获得。低血流比（LFR）定义为相对 CBF <20 % 的脑容量与相对 CBF <30 % 的脑容量之比。随访 CT 图像对 HT 进行了评估。采用二元逻辑回归分析两组间不同参数与 HT 发生的相关性。利用接收者操作特征曲线评估了预测效果。共有 243 名患者符合纳入标准。在随访期间，46.5%的患者（113/243）发生了高血压。与非 HT 组相比，HT 组的 LFR 较高（0.47 (0.34-0.65) vs. 0.32 (0.07-0.56); < 0.001）。根据二元逻辑回归分析，LFR（aOR：6.737；95 % CI：1.994-22.758；= 0.002）、高血压病史（aOR：2.231；95 % CI：1.201-4.142；= 0.011）、MT 前血浆 FIB 水平（aOR：0.641；95 % CI：0.456-0.902；= 0.011）和错配比（aOR：0.990；95 % CI：0.980-0.999；= 0.030）与 MT 继发 HT 独立相关。预测 HT 的回归模型曲线下面积为 0.741。通过 CTP 量化的比值 LFR 有可能成为继发于 MT 的 HT 的独立风险因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Neuroradiology 医学-核医学

CiteScore

6.10

自引率

5.70%

发文量

142

审稿时长

6-12 weeks

期刊介绍： The Journal of Neuroradiology is a peer-reviewed journal, publishing worldwide clinical and basic research in the field of diagnostic and Interventional neuroradiology, translational and molecular neuroimaging, and artificial intelligence in neuroradiology. The Journal of Neuroradiology considers for publication articles, reviews, technical notes and letters to the editors (correspondence section), provided that the methodology and scientific content are of high quality, and that the results will have substantial clinical impact and/or physiological importance.

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