Risk factors for parenchymal hematoma in hemorrhagic transformation after intra-arterial thrombectomy.

OBJECTIVE

To identify independent factors associated with hemorrhagic transformation (HT) in patients with acute ischemic stroke (AIS) after intra-arterial thrombectomy (IAT) and to determine predictors of parenchymal hematoma (PH) in patients who develop HT.

METHODS

Among 2647 patients diagnosed with ischemic stroke or transient ischemic attack between April 1, 2020, and February 1, 2024, at a regional tertiary general hospital, 296 patients with AIS who underwent IAT were retrospectively analyzed. Patients were categorized into HT and non-HT groups. The HT group was subdivided into hemorrhagic infarction (HI) and PH groups. Comparative and multivariate regression analyses were performed between the HT and non-HT groups, and between the HI and PH subgroups.

RESULTS

Older age (adjusted odds ratio [aOR] 1.037, 95% confidence interval [CI] 1.013-1.062, p = 0.003) and severe white matter hyperintensities (WMH) (Fazekas grade 3, aOR 2.875, 95% CI 1.705-4.848, p < 0.001) were independently associated with HT in patients with AIS after IAT. Among those with HT, PH was independently associated with atrial fibrillation (AF) (aOR 4.165, 95% CI 1.301-13.333, p = 0.016), total cholesterol (TC) level (aOR 0.978, 95% CI 0.962-0.993, p = 0.005), and erythrocyte sedimentation rate (ESR) (aOR 1.038, 95% CI 1.001-1.077, p = 0.045).

CONCLUSION

Older age and severe WMH were identified as independent risk factors for HT in patients with AIS post-IAT. AF, lower TC (supporting the lipid paradox), and higher ESR were independently associated with PH among these patients. These findings highlight the key predictors of poor prognosis post-IAT, indicating ESR as a potential predictor of PH.