Zidan Mousa, Serrallach Bettina Lara, Branca Mattia, Bode Felix, Piechowiak Eike, Meinel Thomas, Lehnen Nils Christian, Dobrocky Tomas, Kaesmacher Johannes, Dorn Franziska
Department of Neuroradiology, Bonn University Hospital, Bonn, Germany.
Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland.
Neuroradiology. 2025 Jun 19. doi: 10.1007/s00234-025-03679-x.
Subarachnoid hyperdensities (SH) on flat-detector CT (FDCT) after mechanical thrombectomy (MT) are associated with less favorable clinical outcomes. We aimed to further elucidate the prevalence and clinical significance of SH following MT, especially in patients with dominant, co- and non-dominant M2 occlusions.
728 patients from two comprehensive stroke centers were assessed for the presence of SH on FDCT. The primary outcome was the presence of SH on FDCT. The secondary outcome was modified Rankin Scale scores (mRS) at 90 days. Baseline procedural characteristics and clinical outcomes were analyzed using group comparisons and multivariable logistic regression. To remove the effect of confounding factors, a logistic regression model was built using inverse probability weighting.
In total, 411 patients were included. Prevalence of SH on FDCT was 171/411 (41.6 %), with particularly high prevalence in co- and non-dominant M2 occlusions (63%) and dominant M2 occlusions (53.9%). The occurrence of SH was independently associated with poor functional outcomes (adjusted OR for mRS at 90 days: 1.5; 95% CI, 1.1-2.2) and increased mortality (aOR: 1.7; 95% CI, 1.0-2.8). Increased risk of developing SH was particularly evident in patients with co- and non-dominant M2 occlusions (P < 0.001 OR = 3.78; 95% CI, 2.18-6.57) and dominant M2 occlusions (P < 0.001 OR = 3.07; 95% CI, 1.68-5.59) compared to large vessel occlusions. A higher number of device passes, specifically between 3 and 6 and more than 6, show an effect on the occurrence of SH P < 0.001 OR = 2.75; 95% CI, 1.56-4.84 and P = 0.02 OR = 3.45; 95% CI, 1.17-10.16 compared to fewer passes (1-3).
SH are common after MT, especially in M2 occlusions. They are associated with poorer functional outcomes in patients with co- and non-dominant M2 occlusions and higher numbers of device passes (>3).
机械取栓（MT）后平板探测器CT（FDCT）上的蛛网膜下腔高密度影（SH）与较差的临床预后相关。我们旨在进一步阐明MT后SH的发生率及临床意义，尤其是在优势侧、双侧和非优势侧M2段闭塞的患者中。
对来自两个综合卒中中心的728例患者进行FDCT上SH的评估。主要结局是FDCT上SH的存在情况。次要结局是90天时的改良Rankin量表评分（mRS）。使用组间比较和多变量逻辑回归分析基线操作特征和临床结局。为消除混杂因素的影响，采用逆概率加权法建立逻辑回归模型。
共纳入411例患者。FDCT上SH的发生率为171/411（41.6%），在双侧和非优势侧M2段闭塞（63%）和优势侧M2段闭塞（53.9%）中尤其高发。SH的发生与不良功能结局（90天时mRS的调整比值比：1.5；95%可信区间，1.1 - 2.2）和死亡率增加（调整后比值比：1.7；95%可信区间，1.0 - 2.8）独立相关。与大血管闭塞相比，双侧和非优势侧M2段闭塞（P < 0.001，比值比 = 3.78；95%可信区间，2.18 - 6.57）和优势侧M2段闭塞（P < 0.001，比值比 = 3.07；95%可信区间，1.68 - 5.59）患者发生SH的风险增加尤为明显。与较少的器械通过次数（1 - 3次）相比，较高的器械通过次数，特别是3至6次和超过6次，对SH的发生有影响（P < 0.001，比值比 = 2.75；95%可信区间，1.56 - 4.84）和（P = 0.02，比值比 = 3.45；95%可信区间，1.17 - 10.16）。
MT后SH很常见，尤其是在M2段闭塞中。它们与双侧和非优势侧M2段闭塞患者较差的功能结局以及较高的器械通过次数（>3次）相关。
