Jiang Xin, Guo Tingting, Lin Yidie, Li Yanbo, Hu Yaowen, He Xin, Chen Ning, Zhou Muke, Guo Jian
Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Neurology, Genertec Medical Chengfei Hospital, Chengdu, Sichuan, China.
Neurocrit Care. 2025 Jul 2. doi: 10.1007/s12028-025-02312-2.
Hemorrhagic transformation (HT) remains a common and serious complication after endovascular treatment (EVT) for acute ischemic stroke (AIS). Limited data exist on how dynamic status of leptomeningeal collaterals influence HT in AIS. This study aims to investigate the impact of dynamic status of leptomeningeal collaterals on postoperative HT in patients with AIS undergoing EVT.
A prospective cohort study was performed between January 2019 and June 2023. Only patients with middle cerebral artery occlusion who received EVT were included. Preoperative leptomeningeal collaterals were evaluated using the regional leptomeningeal collateral (rLMC) score, and postoperative collaterals were assessed using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology score.
A total of 342 patients with middle cerebral artery occlusion were included in this study. Multivariate analysis demonstrated that patients with good rLMC scores (˃ 10) experienced fewer HT events compared with those with poor rLMC scores (≤ 10) (adjusted odds ratio [aOR] 0.46, 95% confidence interval [CI] 0.28-0.76, P = 0.002). Further subgroup analysis based on intravenous thrombolysis showed that good leptomeningeal collaterals were significantly associated with reduced risk of HT in patients receiving bridging therapy (aOR 0.12, 95% CI 0.03-0.38, p < 0.001). Among 75 patients with incomplete recanalization, analysis of collateral changes indicated that patients with consistently good preoperative and postoperative collateral had the lowest risk of HT (aOR 0.19, 95% CI 0.04-0.95, P = 0.043). However, no significant correlation was detected between symptomatic intracranial hemorrhage and preoperative and postoperative collateral or its dynamic evolution.
Good preoperative leptomeningeal collateral status is associated with reduced risk of HT and better 90-day functional outcomes after EVT, possibly due to its role in maintaining cerebral perfusion and slowing infarct growth. Although our findings suggest that collateral-dependent infarct growth may be a potential mechanism for HT and unfavorable outcomes, this hypothesis requires further investigation.
出血性转化（HT）仍是急性缺血性卒中（AIS）血管内治疗（EVT）后常见且严重的并发症。关于软脑膜侧支循环的动态状态如何影响AIS中的HT的数据有限。本研究旨在探讨软脑膜侧支循环的动态状态对接受EVT的AIS患者术后HT的影响。
于2019年1月至2023年6月进行了一项前瞻性队列研究。仅纳入接受EVT的大脑中动脉闭塞患者。术前使用区域软脑膜侧支循环（rLMC）评分评估软脑膜侧支循环，术后使用美国介入和治疗神经放射学会/介入放射学会评分评估侧支循环。
本研究共纳入342例大脑中动脉闭塞患者。多变量分析表明，与rLMC评分低（≤10）的患者相比，rLMC评分高（˃10）的患者发生HT事件较少（调整优势比[aOR]0.46，95%置信区间[CI]0.28 - 0.76，P = 0.002）。基于静脉溶栓的进一步亚组分析表明，在接受桥接治疗的患者中，良好的软脑膜侧支循环与HT风险降低显著相关（aOR 0.12，95% CI 0.03 - 0.38，p < 0.001）。在75例再通不完全的患者中，对侧支循环变化的分析表明，术前和术后侧支循环持续良好的患者发生HT的风险最低（aOR 0.19，95% CI 0.04 - 0.95，P = 0.043）。然而，在症状性颅内出血与术前和术后侧支循环或其动态演变之间未检测到显著相关性。
术前良好的软脑膜侧支循环状态与EVT后HT风险降低及90天功能预后改善相关，这可能归因于其在维持脑灌注和减缓梗死灶生长中的作用。尽管我们的研究结果表明依赖侧支循环的梗死灶生长可能是HT和不良预后的潜在机制，但这一假设仍需进一步研究。
