Chen Rundong, Hua Weilong, Zhang Yilei, Zhang Yongxin, Zhang Hongjian, Zhang Yongwei, Liu Jianmin, Yang Pengfei, Zhang Lei
School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China.
Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China.
J Neurointerv Surg. 2025 Jun 1;17(e2):e288-e294. doi: 10.1136/jnis-2024-022323.
Acute ischemic stroke (AIS) often leads to significant morbidity and mortality. Mechanical thrombectomy (MT) is an effective intervention for large vessel occlusion strokes. However, hemorrhagic transformation (HT) remains a critical post-procedural complication. This study investigates the relationship between basal ganglia infarction (BGI) and the risk of HT, particularly focusing on hemorrhagic infarction (HI) and parenchymal hematoma (PH).
Data from the DIRECT-MT trial were analyzed. Patients were categorized based on the presence of BGI identified on initial non-contrast CT. HT was classified into HI and PH following the Heidelberg criteria. Multivariate logistic regression, propensity score matching (PSM), and inverse probability of treatment weighting (IPTW) were used to assess the association between BGI and HT.
Among 607 patients, 273 had BGI. BGI was associated with a higher risk of HT, specifically PH. The incidence of PH in the BGI group was 20% compared with 11% in the non-BGI group. Adjusted analyses, including PSM and IPTW, confirmed the significant association between BGI and PH with an adjusted odds ratio (aOR) of 2.51 (95% CI 1.49 to 4.22, P<0.001). However, no significant association was found between BGI and HI.
BGI significantly increases the risk of PH following MT for AIS, underscoring the need for tailored therapeutic strategies in managing these patients. No significant correlation was observed between BGI and HI. Future research should explore the underlying mechanisms and validate these findings across diverse populations to improve patient outcomes.
急性缺血性卒中（AIS）常导致严重的发病率和死亡率。机械取栓术（MT）是治疗大血管闭塞性卒中的有效干预措施。然而，出血性转化（HT）仍然是术后的关键并发症。本研究调查基底节梗死（BGI）与HT风险之间的关系，尤其关注出血性梗死（HI）和脑实质血肿（PH）。
分析DIRECT-MT试验的数据。根据初始非增强CT上是否存在BGI对患者进行分类。按照海德堡标准将HT分为HI和PH。采用多因素逻辑回归、倾向评分匹配（PSM）和逆概率加权法（IPTW）评估BGI与HT之间的关联。
607例患者中，273例有BGI。BGI与HT风险较高相关，尤其是PH。BGI组的PH发生率为20%，而非BGI组为11%。包括PSM和IPTW在内的校正分析证实了BGI与PH之间的显著关联，校正比值比（aOR）为2.51（95%CI 1.49至4.22，P<0.001）。然而，未发现BGI与HI之间存在显著关联。
BGI显著增加AIS患者MT术后发生PH的风险，强调在管理这些患者时需要制定个性化的治疗策略。未观察到BGI与HI之间存在显著相关性。未来的研究应探索潜在机制，并在不同人群中验证这些发现，以改善患者预后。
