Itsekzon-Hayosh Zeev, Carpani Federico, Hendriks Eef J, Schaafsma Joanna D, Mosimann Pascal J, Agid Ronit, Krings Timo
Division of Neuroradiology, University Medical Imaging and Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada.
Department of Neurovascular Disorders and Stroke, Sheba Medical Center and Tel Aviv University, Ramat Gan, Israel.
Neuroradiology. 2025 Mar;67(3):687-693. doi: 10.1007/s00234-024-03540-7. Epub 2025 Jan 7.
Subarachnoid hyperdensity (SAH) after endovascular thrombectomy is a well-known phenomenon. Nevertheless, the clinical significance and natural history of this phenomenon is not well described. In addition, we test previously postulated hypotheses of distal occlusions sites and antithrombotic use to SAH prevalence and extent.
We performed a retrospective analysis of all patients presenting with acute stroke and treated by endovascular thrmbectomy in our tertiary center January 2016 and February 2021. Only patients who underwent CT scan of the brain within 24 h after procedure were included.
394 patients were included in this study. SAH after EVT was evident on CT in18.3% of those. Most of these (10.7%), had non-resolving hyperdensity (persistent SAH) on follow up imaging. A minority (2.6%) had resolving hyperdensity (transient SAH). Only 2% had a combination of subarachnoid hyperdensity and intracerebral hemorrhage (SAH + ICH). Transient and persistent SAH were associated with good functional and imaging outcomes as compared to SAH + ICH patients. Older age, large infarct size, stentretriever use and partial recanalization were correlated with SAH + ICH. Distal occlusions and distal vessel angulations resulting in higher traction potential were more prevalent in persistent SAH group. Higher number of thrombectomy passes was correlated with the extent of persistent SAH. Transient SAH group did not show statistically significant demographic or procedural trends.
We propose therefore a distinct classification of the post thrombectomy SAH subtypes and discuss the putative pathophysiological mechanisms of the three distinct phenomena and their predictive factors.
血管内血栓切除术后蛛网膜下腔高密度（SAH）是一种众所周知的现象。然而，这种现象的临床意义和自然病程尚未得到充分描述。此外，我们检验了先前提出的关于远端闭塞部位和抗血栓药物使用与SAH发生率及范围的假设。
我们对2016年1月至2021年2月在我们三级中心接受血管内血栓切除术治疗的所有急性卒中患者进行了回顾性分析。仅纳入术后24小时内接受脑部CT扫描的患者。
本研究共纳入394例患者。血管内血栓切除术后，18.3%的患者CT上可见SAH。其中大多数（10.7%）在随访影像上有持续高密度（持续性SAH）。少数（2.6%）有消散性高密度（短暂性SAH）。只有2%的患者合并蛛网膜下腔高密度和脑出血（SAH+ICH）。与SAH+ICH患者相比，短暂性和持续性SAH与良好的功能及影像结局相关。年龄较大、梗死面积大、使用支架取栓器和部分再通与SAH+ICH相关。持续性SAH组中，导致更高牵引潜力的远端闭塞和远端血管成角更为普遍。血栓切除术次数越多与持续性SAH的范围相关。短暂性SAH组未显示出统计学上显著的人口统计学或手术相关趋势。
因此，我们提出了血栓切除术后SAH亚型的独特分类，并讨论了这三种不同现象的假定病理生理机制及其预测因素。
