Clinical and Demographic Factors Associated With Hemorrhagic Transformation Subtypes After Endovascular Thrombectomy for Acute Ischemic Stroke.

BACKGROUND

Hemorrhagic transformation (HT) after endovascular thrombectomy (EVT) is associated with worse neurological outcomes. We sought to identify clinical and demographic factors associated with HT and HT subtypes after EVT.

METHODS

Patients with anterior circulation large vessel occlusion who underwent first-pass EVT using different thrombectomy devices were enrolled in a global multicenter prospective registry. Baseline clinical characteristics were compared between individuals with and without HT and across HT subtypes 24 hours after EVT. Multivariable logistic regression models were used to determine risk factors associated with HT and HT subtypes.

RESULTS

The study cohort comprised 1453 patients. Imaging evidence of HT occurred in 40% of patients, of whom 3.2% had symptomatic HT. In a multivariable regression analysis, diabetes (odds ratio [OR], 1.47 [95% CI, 1.09-1.99]; P=0.01), National Institutes of Health Stroke Scale score of 16 to 19 (OR, 1.45 [95% CI, 1.09-1.94]; P=0.01), National Institutes of Health Stroke Scale score ≥20 (OR, 1.98 [95% CI, 1.56-2.50]; P<0.0001), Alberta Stroke Program Early Computed Tomography Score ≥8 (OR, 0.31 [95% CI, 0.24-0.39]; P<0.0001), and elevated baseline serum glucose (OR, 1.56 [95% CI, 1.23-1.98]; P=0.0003) were independent risk factors for HT. Atrial fibrillation (OR, 0.75 [95% CI, 0.58-0.96]; P=0.02) was a protective factor against HT. Baseline Alberta Stroke Program Early Computed Tomography Score <8, elevated baseline serum glucose, and higher baseline National Institutes of Health Stroke Scale scores were independent predictors of hemorrhagic infarction-1 and hemorrhagic infarction-2. Diabetes was significantly associated with hemorrhagic infarction-2, and Alberta Stroke Program Early Computed Tomography Score <8 was significantly associated with subarachnoid hemorrhage.

CONCLUSIONS

Given that certain risk factors are associated with specific subtypes of HT, our analysis demonstrates the importance of not only reporting symptomatic HT but also classifying HT into subtypes in clinical trials. Identifying risk factors associated with HT subtypes may improve prognostic accuracy and guide post-EVT monitoring.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03845491.