Analysis Of Risk Factors For Hemorrhage Transformation After Thrombus Removal In Acute Ischemic Stroke

Objective:In clinical practice,haemorrhagic transformation is currently an important complication affecting the prognosis of patients with acute ischaemic stroke after endovascular treatment.There is a lack of biomarkers or indicators that can effectively predict hemorrhagic transformation after endovascular therapy,so the aim of this study was to investigate the risk factors associated with hemorrhagic transformation after endovascular therapy in patients with acute ischaemic stroke,and to provide references for preventing hemorrhage transformation in patients with endovascular treatment.Methods:Ninety-eight patients with acute ischaemic stroke(AIS)who received endovascular treatment at Three Gorges Hospital,Chongqing University between January 2019 and December 2020 were retrospectively analysed.The criteria for inclusion were:age between 18 and 80 years,compliance with the diagnostic criteria of the Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke(2018 version),occlusion of a large vessel in the anterior circulation,pre-operative assessment and initiation of endovascular treatment within 6 h of onset,completion of cranial CT review within 24 hours of endovascular treatment,and informed consent of the patient or his family and signing of an informed consent form.The patients were divided into a haemorrhagic transformation group and a non-haemorrhagic transformation group according to the occurrence of haemorrhagic transformation,and general information and clinical indicators were collected.A univariate analysis was then performed and risk factors with statistically significant differences in the univariate analysis were subjected to logistic regression analysis and risk line plots were drawn to assess the impact of each risk factor.Results:Univariate analysis showed that the proportion of patients with diabetes history,time from onset to recanalization and operation time were significantly higher in the bleeding conversion group than those in the non-bleeding conversion group(P<0.05),and the proportion of good collateral circulation was significantly lower in the bleeding conversion group than that in the non-bleeding conversion group(P<0.05).Multivariate analysis showed that the history of diabetes[OR=1.844,95%CI(1.123,2.311)],collateral circulation[OR=1.168,95%CI(1.032,2.493)],onset to recanalization time[OR=1.793,95%CI(1.101,2.718)]and operation time[OR=1.267,95%CI(1.012,2.942)]were the main risk factors for bleeding conversion after endovascular treatment in acute ischemic stroke(P<0.05).With a risk histogram score of 135,the patient’s risk of bleeding conversion after endovascular treatment of AIS was estimated to be 45%.Conclusion:History of diabetes mellitus,collateral circulation,time from onset to revascularisation and time to procedure are risk factors for haemorrhagic transformation after endovascular treatment in patients with AIS.A column line chart developed based on these variables may be a valid predictive tool for bleeding conversion.Further Big data verification is needed to improve the applicability of this column line chart.