Predictive value of intraoperative flat CT for intracranial hemorrhage after mechanical thrombectomy in acute anterior circulation large vessel occlusion

Abstract

Objective To explore the predictive value of intraoperative flat CT scan for intracranialhemorrhage after mechanical thrombectomy in patients with acute anterior circulation large vessel occlusion(AAC⁃LVO). Methods A total of 106 patients with AAC⁃LVO who underwent mechanical thrombectomyat The Second Affiliated Hospital of Bengbu Medical University was conducted from March 2020 to June2023. Intraoperative flat CT scan was performed among above patients to record CT values, high⁃densitysign and mass effect. According to whether occurred intracranial hemorrhage after surgery, those patientswere divided into intracranial hemorrhage group (n = 29) and non⁃intracranial hemorrhage group (n = 77).Univariate and multivariate stepwise Logistic regression analyses were used to screen the influencing factorsof intracranial hemorrhage after mechanical thrombectomy. Receiver operating characteristic (ROC) curvewas drawn to evaluate the predictive efficacy of intraoperative flat CT scan for postoperative intracranialhemorrhage. Results Logistic regression analysis showed that hypertension was a protective factor for patients with AAC ⁃ LVO who did not experience intracranial hemorrhage after mechanical thrombectomy(OR = 0.340, 95%CI: 0.123-0.941; P = 0.038). A high National Institutes of Health Stroke (NIHSS) score atadmission (OR = 1.068, 95%CI: 1.010-1.129; P = 0.021), as well as intraoperative flat CT high⁃density sign(OR = 9.942, 95%CI: 2.631-37.567; P = 0.001), mass effect (OR = 23.564, 95%CI: 7.266-79.421; P = 0.000),and CT value ≥ 90 HU (OR = 9.714, 95%CI: 1.982-47.605; P = 0.005) were risk factors for postoperativeintracranial hemorrhage. The ROC curve showed that the area under the curve (AUC) for intraoperative flatCT value ≥ 90 HU, mass effect and their combined prediction of postoperative intracranial hemorrhage were0.82 (95%CI: 0.734-0.889, P = 0.000), 0.75 (95%CI: 0.661-0.833, P = 0.000) and 0.76 (95%CI: 0.668-0.838, P = 0.000), with sensitivity were 75.86%, 58.62% and 58.62%, and specificity were 88.31%, 92.21%and 93.51%. The predictive efficiency was highest for CT value ≥ 90 HU (t = 48.777, P = 0.000; t = 43.681,P = 0.000). Conclusions In patients with AAC⁃LVO undergoing mechanical thrombectomy, intraoperativeflat CT high⁃density sign such as CT value ≥ 90 HU and mass effect can predict postoperative intracranialhemorrhage, and the predictive value of CT value ≥ 90 HU is relatively high.

doi：10.3969/j.issn.1672⁃6731.2024.11.003