Analysis of factors influencing cerebral hyperperfusion syndrome after stent thrombectomy in patients with acute ischemic stroke due to large vessel occlusion: a retrospective study.

OBJECTIVE

To analyze the factors influencing symptomatic cerebral hyperperfusion syndrome (CHS) after stent thrombectomy in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO) and to provide a basis for clinical prevention and treatment.

METHODS

A retrospective analysis was conducted on the clinical data of 98 patients with AIS-LVO who underwent stent thrombectomy at The First People's Hospital of Yinchuan from January 2020 to January 2025. Patients were divided into a normal group (n = 82) and a CHS group (n = 16) based on the occurrence of symptomatic CHS within 7 days postoperatively. Clinical baseline data were collected, and univariate analysis and multivariate logistic regression analysis were used to identify risk factors for postoperative CHS.

RESULTS

Univariate analysis showed that the CHS group had higher proportions of patients with hypertension, diabetes, moderate to severe vascular stenosis, and poor collateral circulation, as well as higher admission blood glucose levels, but a lower Alberta Stroke Program Early CT Score (ASPECTS) compared with the normal group. Multivariate logistic regression analysis revealed that hypertension (odds ratio, OR = 3.876), admission hyperglycemia (OR = 3.645), poor collateral circulation (OR = 2.368), and moderate to severe vascular stenosis (OR = 3.392) were independent risk factors for postoperative CHS, while a higher ASPECTS (OR = 0.617) was a protective factor (all P < 0.05). Regarding prognosis, the CHS group had a significantly higher incidence of symptomatic intracranial hemorrhage (31.25% vs. 4.88%, χ2 = 8.647, P = 0.003) and a significantly lower rate of good functional outcome at 90 days (modified Rankin Scale ≤ 2) (37.50% vs. 79.27%, χ2 = 11.034, P = 0.001) compared with the normal group. The hospitalization time was longer in the CHS group than that in the normal group (21.38 ± 5.62 days vs. 14.25 ± 4.17 days, t = 4.216, P < 0.001). However, no significant difference was observed in in-hospital mortality between the two groups (P = 0.664).

CONCLUSION

Hypertension, admission hyperglycemia, poor collateral circulation, and moderate to severe vascular stenosis are independent risk factors for symptomatic CHS after stent thrombectomy in patients with AIS-LVO, whereas a higher ASPECTS score is a protective factor. Clinical monitoring and intervention should be strengthened for patients with these risk factors to reduce the risk of postoperative CHS.