急性缺血性卒中行机械取栓血管成功再通后出血转化的独立危险因素分析及预测模型构建OA

Objective To explore the independent risk factors for hemorrhagic transformation(HT)after successful mechanical thrombectomy(MT)recanalization in patients with acute ischemic stroke(AIS)and to construct a predictive model accordingly.Methods A retrospective analysis was conducted on consecutive AIS patients who underwent successful MT recanalization(post-procedural modified thrombolysis in cerebral infarction[mTICI]grade ≥2b)at the Stroke Center of Fuyang People's Hospital from J une 2023 to March 2025.Baseline and clinical data were collected,including age,sex,atrial fibrillation,diabetes,hypertension,smoking history,drinking history,preoperative National Institutes of Health stroke scale(NIHSS)score(≥ 19 points,＜19 points),admission systolic blood pressure,admission diastolic blood pressure,intravenous thrombolysis,onset-to-recanalization(OTR)time(≥8 h,＜8h),onset-to-puncture(OTP)time,puncture-to-recanalization(PTR)time,number of thrombectomy attempts,thrombectomy technique(direct aspiration thrombectomy,stent retriever thrombectomy,stent retriever+aspiration thrombectomy),occluded artery(internal carotid artery,middle cerebral artery,basilar artery,vertebral artery),infarct location(anterior circulation,posterior circulation),preoperative random blood glucose(≥ 8.05 mmol/L,＜8.05 mmol/L),triglyceride,total cholesterol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol levels,Alberta stroke program early CT score(ASPECTS;≥ 6 points,＜6 points),collateral circulation status(American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology[ASITN/SIR]grading:≤2 or＞2),trial of Org 10172 in acute stroke treatment(TOAST)classification,and immediate post-procedural mTICI grade(2b,3).Patients were divided into HT and non-HT groups based on head CT performed immediately after the procedure and at 24-48 hours post-procedure.Variables with statistically significant differences between groups underwent collinearity analysis.After removing variables with shared meaning or collinearity(variance inflation factor＞5),least absolute shrinkage and selection operator(LASSO)regression was used,through regularization coefficients all variables remaining were regulated using regression coefficient.Potential predictor variables were selected and included in multivariate Logistic regression analysis to identify factors influencing HT after successful MT recanalization in AIS patients,and a nomogram prediction model was constructed.Receiver operating characteristic curve analysis was used to evaluate the predictive performance of the model and independent risk factors,with areas under the curve(AUC)compared using Delong's test.The Hosmer-Lemeshow test assessed model goodness-of-fit.The prediction model was internally validated using calibration curves and the Bootstrap resampling method(1 000 iterations).Results A total of 152 AIS patients with successful MT recanalization were included(101 males,51 females;age range 31-87years,mean age[65±11]years).There were 47 patients in the HT group and 105 in the non-HT group.(1)Compared to the non-HT group,the HT group had significantly higher age,preoperative NIHSS score,admission systolic blood pressure,OTR time,OTP time,PTR time,preoperative random blood glucose,and proportions of hypertension,atrial fibrillation,and diabetes(all P＜0.05).The mean ASPECTS was significantly lower in the HT group(P＜0.05).Significant differences were also found between groups in preoperative NIHSS score,OTR time,preoperative random blood glucose,ASPECTS,ASITN/SIR grade,and infarct location distribution(all P＜0.05).No significant differences were found in other baseline or clinical data(all P＞0.05).(2)After removing variables with shared meaning or collinearity,eight variables were included in LASSO regression:preoperative random blood glucose,ASPECTS,OTR time,preoperative NIHSS score(all as categorical variable),age,hypertension,atrial fibrillation,and infarct location.Following 10-fold cross-validation,preoperative random blood glucose(≥8.05 mmol/L=1,＜8.05 mmol/L=0),ASPECTS(≥6 points=1,＜6 points=0),OTR time(≥8 h=1,＜8h=0),and preoperative NIHSS score(≥ 19 points=1,＜19 points=0)were selected as independent variables for multivariate Logistic regression analysis.Results showed that preoperative random blood glucose ≥8.05 mmol/L(OR,1.524,95％CI 1.151-2.016,P=0.003),ASPECTS＜6 points(OR,0.562,95％CI 0.412-0.766,P＜0.01),OTR time ≥ 8 h(OR,1.237,95％CI 1.050-1.459,P=0.011),and preoperative NIHSS score ≥ 19 points(OR,2.306,95％CI 1.473-3.614,P＜0.01)were independent risk factors for HT after successful MT recanalization in AIS patients.(3)The AUC of the nomogram prediction model for HT constructed based on these four factors was 0.882(95％CI 0.815-0.955),which was significantly higher than that of any single indicator(Delong's test,all P＜0.05).The calibration curve and Hosmer-Lemeshow test indicated good model fit(P=0.528).Conclusions Preoperative random blood glucose ≥8.05 mmol/L,ASPECTS＜6 points,OTR time ≥8h,and preoperative NIHSS score ≥ 19 points are independent risk factors for HT after successful MT recanalization in AIS patients.The nomogram prediction model constructed based on these factors demonstrates certain predictive efficacy for HT after successful recanalization in AIS patients who have undergone MT.