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. 2024 Nov 19;14(22):2598.
doi: 10.3390/diagnostics14222598.

Predictive Value of Clinical and Dual-Energy Computed Tomography Parameters for Hemorrhagic Transformation and Long-Term Outcomes Following Endovascular Thrombectomy

Shiu-Yuan Huang  1 , Nien-Chen Liao  2   3 , Jin-An Huang  2   4 , Wen-Hsien Chen  5   6 , Hung-Chieh Chen  5   7
Affiliations

Predictive Value of Clinical and Dual-Energy Computed Tomography Parameters for Hemorrhagic Transformation and Long-Term Outcomes Following Endovascular Thrombectomy

Shiu-Yuan Huang et al. Diagnostics (Basel). .

Abstract

Objective: This study's objective was to explore whether certain parameters measurable by dual-energy computed tomography (DECT) performed 24 h after endovascular thrombectomy (EVT) can predict subsequent hemorrhagic transformation.

Material and methods: We retrospectively reviewed patients with acute ischemic stroke (AIS) managed with EVT who had follow-up DECT within 24 h post-EVT between January 2019 and December 2023. Clinical and image parameters were recorded for predictive factor analysis. The primary outcome was hemorrhagic transformation, which was determined by using follow-up computed tomography (CT) or magnetic resonance imaging (MRI). The secondary outcomes were in-hospital mortality and 3-month post-EVT favorable functional outcome, as defined by a modified ranking scale (mRS) score of ≤2.

Results: A total of 152 patients were included in this study. Multivariable analysis showed that the VNC-ASPECT score (p = 0.002) and superior sagittal sinus density (p = 0.01) were significantly associated with hemorrhagic transformation. For in-hospital survival rate analysis, post-EVT NIHSS measured 24 h post-EVT was an effective predictor, with a cutoff value of 23 (≤23: 88% vs. >23: 52.1%; p < 0.001). For functional outcome analysis, age (p < 0.001), tPA prior to EVT (p = 0.017), NIHSS 24 h post-EVT (p = 0.001), and VNC-ASPECT score (p < 0.003) were associated with a favorable functional outcome 3 months after EVT.

Conclusions: The VNC-ASPECT score was associated with both hemorrhagic transformation and a 3-month post-EVT favorable functional outcome, and could therefore be an useful predictor for the development of hemorrhagic transformation.

Keywords: ASPECTS; acute ischemic stroke (AIS); dual-energy computed tomography (DECT); endovascular thrombectomy (EVT).

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient selection flowchart for inclusion in the study.
Figure 2
Figure 2
Kaplan–Meier survival analysis with a post-EVT 24 h cutoff value of 23.
See this image and copyright information in PMC

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