From the Department of Diagnostic and Interventional Neuroradiology (B.L.S., A.M., A.B., A.H., S.P.-P., E.I.P., J.G., J.K., T.D.), Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
Department of Clinical Research (M.B.), CTU Bern, University of Bern, Bern, Switzerland.
AJNR Am J Neuroradiol. 2024 Sep 9;45(9):1230-1240. doi: 10.3174/ajnr.A8277.
Flat-panel detector CT immediately after mechanical thrombectomy can detect complications, including early hemorrhagic transformation and subarachnoid hyperdensities. The clinical significance of subarachnoid hyperdensities in patients undergoing mechanical thrombectomy remains unclear.
We studied 223 patients who underwent mechanical thrombectomy for anterior circulation stroke who had flat-panel detector CT performed immediately after the procedure and had follow-up imaging within 24 hours. Subarachnoid hyperdensity severity was categorized into 5 grades (subarachnoid hyperdensities, 0: absent to subarachnoid hyperdensities, IV: extensive). Baseline and procedural characteristics as well as outcome measures were analyzed using group comparisons and multivariable logistic regression analyses.
Overall, 100/223 (45%) patients showed subarachnoid hyperdensities on immediate postinterventional flat-panel detector CT. The factors associated with an increased subarachnoid hyperdensity risk were the following: medium-vessel occlusion or distal-vessel occlusion compared with a large-vessel occlusion, a more distal device position, a higher number of device passes, a larger volume of contrast applied, worse final reperfusion expanded TICI, and after receiving IV thrombolysis. The occurrence of subarachnoid hyperdensity grades II-IV was independently associated with worse functional outcomes (adjusted OR for mRS, 3-6: 2.2; 95% CI 1.1-4.3), whereas patients with subarachnoid hyperdensity grade I had outcomes similar to those in patients without subarachnoid hyperdensities.
Our study identified risk factors for subarachnoid hyperdensities, most of which reflect increasingly challenging procedures or more peripheral recanalization attempts. The presence of subarachnoid hyperdensity grades II-IV was associated with poorer outcomes, suggesting the need for personalized strategies to reduce its incidence and severity or potentially improve recovery after subarachnoid hyperdensities.
机械取栓术后立即行平板探测器 CT 可检测到并发症，包括早期出血性转化和蛛网膜下腔高密度影。机械取栓术后患者蛛网膜下腔高密度影的临床意义尚不清楚。
我们研究了 223 例接受前循环卒中机械取栓术的患者，这些患者在术后立即行平板探测器 CT 检查，并在 24 小时内进行了随访成像。蛛网膜下腔高密度影严重程度分为 5 级（蛛网膜下腔高密度影，0 级：无至蛛网膜下腔高密度影，4 级：广泛）。使用组间比较和多变量逻辑回归分析对基线和手术特征以及结局测量指标进行分析。
223 例患者中，223 例患者（45%）在即刻介入性平板探测器 CT 上显示蛛网膜下腔高密度影。与大血管闭塞相比，中血管闭塞或远侧血管闭塞、设备位置更靠远、设备使用次数更多、应用造影剂体积更大、最终再灌注扩展 TICI 更差、接受 IV 溶栓治疗的患者，蛛网膜下腔高密度影风险增加。蛛网膜下腔高密度影ⅡⅣ级的发生与较差的功能结局独立相关（mRS 36 分的调整 OR：2.2；95%CI 1.1~4.3），而蛛网膜下腔高密度影 1 级患者的结局与无蛛网膜下腔高密度影患者相似。
本研究确定了蛛网膜下腔高密度影的危险因素，其中大多数反映了手术难度增加或更靠远的再通尝试。蛛网膜下腔高密度影Ⅱ~Ⅳ级的存在与较差的结局相关，提示需要制定个体化策略以降低其发生率和严重程度，或潜在地改善蛛网膜下腔高密度影后的恢复情况。
