Study On Hemorrhagic Transformation And Prognosis Of Multitemporal CTA Combined With CTP After Mechanical Embolectomy In Acute Ischemic Stroke

Objective To explore the predictive value and prognostic analysis of multi-temporal CTA combined with CTP for hemorrhagic transformation after mechanical embolectomy in acute ischemic stroke.Methods From August 2020 to October 2022,116 patients who underwent mechanical embolectomy for acute ischemic stroke in the First Affiliated Hospital of Anhui Medical University were retrospectively collected.All patients underwent CT reexamination after operation.Based on the CT results,patients were divided into a hemorrhage group and a non-hemorrhage group according to the presence or absence of intracranial hemorrhage,and all patients were divided into a PH2 group and a non-PH2 group according to the image classification of the hemorrhage.The general clinical data and imaging data of patients were collected,and the baseline data of patients between the two groups were analyzed by univariate analysis,and the statistically significant indicators in univariate analysis were incorporated into multivariate Logistic regression analysis to obtain independent risk and protective factors of HT and PH2,and a comprehensive prediction model and a single imaging parameter model for predicting HT and PH2 were established.ROC was used to analyze the prediction efficiency of different models and the correlation between different imaging parameters.According to the 90d-m RS score,the patients were divided into two groups: good-functional prognosis(90d-m RS score 0～2)and poor-functional prognosis(90d-m RS score 3～6),and the effects of different bleeding subtypes,collateral circulation level and combined thrombolysis on functional outcome were compared.Results1.Among the 116 patients with AIS embolectomy,45(38.8%)developed HT,including18(15.5%)of PH2 type.2.Multivariate Logistic regression analysis showed that serial thrombosis,times of embolectomy,admission NLR,r CBF and ASPECTS scores were independent influencing factors of HT,with tandem thrombus(OR 5.709;95%CI,1.850-17.614;P=0.005),number of thrombus retrievals(OR 1.902;95%CI,1.166-3.102;P=0.034)is a risk factor,r CBF(OR 0.166;95%CI,0.022-0.618;P=0.003),ASPECTS score(OR0.466;95%CI,0.304-0.717;P=0.001)is a protective factor.3.Tandem thrombosis,r PS and r CBF are independent influencing factors of PH2,Tandem thrombosis(OR 5.547;95%CI,1.409-21.834;P=0.014),r PS(OR 1.040;95%CI,1.004-1.078;P=0.025)is a risk factor,r CBF(OR 0.001;95%CI,0.022-0.048;P=0.035)is a protective factor.4.Multi-temporal CTA combined with CTP has the best prediction efficiency for HT and PH2(AUC: HT,0.933;PH2,0.955).5.mCTA score has a moderate positive correlation with ASPECTS score,r CBF and r CBV,and a weak negative correlation with r PS,r MTT and r Tmax.6.Hemorrhagic transformation and collateral circulation levels were significantly different between the good-prognosis and poor-prognosis groups(P< 0.05),whether thrombolysis was combined or not,there was no significant difference between the two groups.Conclusions Multi-temporal CTA combined with CTP can improve the predictive efficiency of HT and PH2 in AIS patients after embolectomy,and the level of collateral circulation and hemorrhagic transformation will have a great impact on the prognosis of neurological function.