Work

Early antithrombotic therapy improves 90-day functional outcomes in patients with postinterventional cerebral hyperdensity after mechanical thrombectomy: a retrospective cohort study

Year: 2026

Type: article

Abstract: Background and purpose Postinterventional cerebral hyperdensity (PCHD) is a specific type of hyperdensity commonly observed on computed tomography (CT) scans of the head after mechanical thrombectomy (MT). This study aimed to investigate the association between early antithrombotic therapy (EAT) and 90-day functional outcomes in anterior circulation acute ischemic stroke (acAIS) patients with PCHD. Methods A retrospective cohort study was conducted on 141 consecutive acAIS patients with PCHD after MT. EAT was defined as antithrombotic therapy administered within 24 h post-MT. The primary outcome was a favorable 90-day functional outcome (modified Rankin Scale (mRS) score of 0–2). The secondary outcomes included 90-day mortality, ΔmRS (defined as the mRS score before MT minus the 90-day mRS score), enlargement of cerebral hyperdensity, and persistent hyperdensity on the 24-h follow-up CT graded by the European Cooperative Acute Stroke Study (ECASS III) morphology. Baseline and outcome data were compared between the EAT and non-EAT groups. Univariate and multivariate logistic regression analyses were performed to assess the association between EAT and favorable outcomes. Sensitivity and subgroup analyses were performed to evaluate the robustness and internal consistency of the results. Results Of the 129 patients with complete 90-day mRS data, 59 (45.7%) received EAT. The EAT group had a higher proportion of favorable outcomes (59.3% vs. 37.1%, p = 0.019). A multivariate logistic regression analysis showed that EAT remained significantly associated with favorable outcomes (Model 1: odds ratio (OR) 2.469, 95% confidence interval (CI) 1.195–5.104, p = 0.015; Model 2: OR 2.72, 95% CI 1.02–7.20, p = 0.045; Model 3: OR 3.68, 95% CI 1.32–10.30, p = 0.013), and the results were consistent after imputation based on discharge data and multiple imputation. Sensitivity and subgroup analyses showed consistent results, with no significant interaction effects observed. Conclusion EAT is associated with improved 90-day functional outcomes in acAIS patients with PCHD, warranting further investigation in larger prospective studies.

Source: Frontiers in Neurology

DOI: 10.3389/fneur.2026.1891162