Department of Neuroradiology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
Department of Neuroradiology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany.
J Neurointerv Surg. 2024 Sep 17;16(10):966-973. doi: 10.1136/jnis-2023-020661.
Subarachnoid hyperdensities after mechanical thrombectomy (MT) are a common finding. However, it is often regarded as clinically insignificant.
With this single-center investigation, to identify the prevalence of subarachnoid hyperdensities following MT, associated predictors, and the impact on the clinical outcome of the patients.
383 patients from the stroke registry were analyzed for the presence of subarachnoid hyperdensities on flat detector CT (FDCT) directly after the completion of MT, and on follow-up dual-energy CT, then classified according to a visual grading scale. 178 patients were included with anterior circulation occlusions. Regression analysis was performed to identify significant predictors, and Kruskal-Wallis analysis and Χ test were performed to test the variables among the different groups. The primary outcome was the modified Rankin Scale (mRS) score at 90 days and was analyzed with the Wilcoxon-Mann-Whitney rank-sum test.
The prevalence of subarachnoid hyperdensities on FDCT was (66/178, 37.1%) with patients experiencing a significant unfavorable outcome (P=0.035). Significantly fewer patients with subarachnoid hyperdensities achieved a mRS score of ≤3 at 90 days 25/66 (37.9%) vs 60/112 (53.6%), P=0.043). In addition, mortality was significantly higher in the subarachnoid hyperdensities group (34.8% vs 19.6%, P=0.024). Distal occlusions and a higher number of device passes were significantly associated with subarachnoid hyperdensities (P=0.026) and (P=0.001), respectively. Patients who received intravenous tissue plasminogen activator had significantly fewer subarachnoid hyperdensities (P=0.029).
Postinterventional subarachnoid hyperdensities are a frequent finding after MT and are associated with neurological decline and worse functional outcome. They are more common with distal occlusions and multiple device passes.
机械血栓切除术后（MT）蛛网膜下腔高密度影是一种常见的表现。然而，它通常被认为是临床意义不大的。
通过这项单中心研究，确定 MT 后蛛网膜下腔高密度影的发生率、相关预测因素，以及对患者临床结局的影响。
对来自中风登记处的 383 名患者的横断位探测器 CT（FDCT）直接在 MT 完成后，以及在随访的双能 CT 上存在蛛网膜下腔高密度影进行分析，并根据视觉分级量表进行分类。178 名患者为前循环闭塞。进行回归分析以确定显著的预测因素，并进行 Kruskal-Wallis 分析和 Χ 检验，以检验不同组之间的变量。主要结局是 90 天的改良 Rankin 量表（mRS）评分，并采用 Wilcoxon-Mann-Whitney 秩和检验进行分析。
FDCT 上蛛网膜下腔高密度影的发生率为（66/178，37.1%），且患者的预后不良（P=0.035）。有蛛网膜下腔高密度影的患者在 90 天达到 mRS 评分≤3 的比例明显较低（25/66[37.9%] vs 60/112[53.6%]，P=0.043）。此外，蛛网膜下腔高密度影组的死亡率明显较高（34.8% vs 19.6%，P=0.024）。远端闭塞和更多的器械通过次数与蛛网膜下腔高密度影显著相关（P=0.026）和（P=0.001）。接受静脉组织型纤溶酶原激活剂的患者蛛网膜下腔高密度影明显较少（P=0.029）。
MT 后介入性蛛网膜下腔高密度影是一种常见的表现，与神经功能下降和更差的功能结局相关。它们在远端闭塞和多次器械通过时更常见。
