Analysis Risk Factors And Preliminarily Evaluate Prediction Model Of Hemorrhagic Transformation After Stent Retriever Thrombectomy In Acute Ischemic Stroke

Objective: Hemorrhagic transformation is a major concern for applying stent retriever thrombectomy in acute ischemic stroke,which has serious impact on patients' outcomes.The aim of this study was to explore the risk factors of hemorrhagic transformation after stenting retriever thrombectomy and establish a new score model to predict it.Methods: Patients with acute ischemic stroke were collected from multiple stroke center in Zunyi city.The clinical material carries were analyzed retrospectively.These cases were divided into two groups by CT scan within 48 hours after stenting retriever thrombectomy.Logistic regression was used to identify risk factors for hemorrhagic transformation.According to equation logistic(P)= ?0+?1*X1+?2*X2+……+?m*Xm,the score model was established to predict the hemorrhagic transformation and compared with HAT,MISS,GRASPS,SEDAN and SITS models.Results: A total of 270 patients were included,52 patients were diagnosed with hemorrhagic transformation.By multivariate analysis,the higher ASPECTS(OR =0.365,95% CI,0.194-0.686),admission albumin(OR = 0.846,95% CI,0.723-0.989),and the lower risk of hemorrhagic transformation.Admission neutrophils(OR =1.339,95% CI,1.067-1.681),admission blood glucose(OR = 1.925,95% CI,1.395-2.657),admission systolic blood pressure(OR = 1.076,95% CI,1.037-1.117),cardiogenic embolism(OR = 14.210,95% CI,2.905-69.513),poor collateral circulation(OR = 7.422,95% CI,1.174-46.946),and the number of device passes(OR= 4.276,95% CI,2.319-7.886)were associated with hemorrhagic transformation after stenting retriever thrombectomy.The ROC curve showed our score model(AUC=0.927,95% CI,0.891-0.963).When the score ? 8,the sensitivity and specificity of predicting hemorrhage transformation were 85%,87%.Compare our score model,HAT,MISS,GRASSPA,SEDAN with SITS models for predicting the efficacy of hemorrhagic transformation.Our score model(AUC=0.927,95% CI,0.891-0.963)was the highest,followed by SITS(AUC=0.823,95% CI,0.761-0.885),GRASPS(AUC=0.796,95% CI,0.729-0.863),SEDAN(AUC=0.763,95%CI,0.692-0.835),HAT(AUC=0.717,95% CI,0.637-0.797),MISS(AUC=0.679,95% CI,0.599-0.759).Conclusion: 1.The patient's neutrophils,blood sugar,systolic blood pressure,the number of device passes,cardiogenic embolism,and poor collateral circulation are the risk factors of hematological transformation after stenting retriever thrombectomy in the anterior circulation acute ischemic stroke.2.Compared with other score models,our score model has a better prediction effect,but it still needs later prospective research and large sample verification.