Differential impact of deep intraparenchymal hyperdensities versus subarachnoid/cortical hyperdensities on futile reperfusion after mechanical thrombectomy: a propensity score-matched study
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background Despite successful mechanical thrombectomy (MT), futile reperfusion (FR) remains a major challenge in acute ischemic stroke (AIS). While post-MT hyperdense areas (HDAs) on non-contrast computed tomography (CT) are associated with reperfusion injury, the differential effects of anatomical HDA subtypes—deep intraparenchymal (DIH) versus subarachnoid/cortical (SCH)—on FR risk are unclear. Methods We retrospectively analyzed 864 AIS patients undergoing MT (2017–2023). HDAs detected within 0.5 h post-MT were classified as DIH or SCH. Propensity score matching (PSM) balanced baseline confounders (1:1 DIH: SCH). Risk factors for FR were analyzed using a multivariate logistic regression analysis in the PSM cohort. Results After PSM, 116 patients in the DIH group were matched with 116 patients in the SCH group. In total, 91 patients (78.5%) in the SCH group and 72 patients (62.1%) in the DIH group suffered FR ( p = 0.006). A multivariate analysis showed that SCH significantly increased the risk of FR (OR: 3.103, 95%CI: 1.425–6.759, p = 0.004), indicating that patients with SCH have a 3.103 times higher risk of FR than patients with DIH. Conclusion Anatomical HDA subtypes differentially predict FR risk, with SCH portending a worse prognosis. This subtype classification enables early risk stratification and may guide personalized post-MT management.
Source: Frontiers in Neurology
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W4417416288