Role of high-density area score in predicting outcomes of large-vessel occlusion stroke after endovascular treatment.

Abstract

High-density areas (HDAs) are frequently observed in follow-up CT of large-vessel occlusions after endovascular therapy. Utilizing the established ASPECTS regions, incorporating the subarachnoid space and ventricles, we developed a novel HDA score to evaluate its correlation and predictive value for hemorrhagic transformations and clinical outcomes. This retrospective, multicenter study included consecutive patients who had HDA on follow-up CT after endovascular therapy. Multivariable logistic regression and area under the receiver operating characteristic curve (AUC) analyses assessed the associations and predictive value of HDA location and score with hemorrhagic transformations and unfavorable clinical outcomes. Among the 1130 consecutive patients treated with endovascular therapy, 542 patients (326 males; median age 70 years) had HDA were finally included. Multivariable logistic regression showed that HDA location in the lentiform nucleus (OR, 1.6; 95% CI: 1.1-2.5; p = 0.03) and ventricles (OR, 4.4; 95% CI: 1.2-16.6; p = 0.03) was associated with hemorrhagic transformations, whereas location in the lentiform nucleus (OR, 2.3; 95% CI: 1.4-3.8; p < 0.001), M1(OR, 3.9; 95% CI: 1.7-8.9; p = 0.001), and subarachnoid space (OR, 2.1; 95% CI: 1.2-3.8; p = 0.02) was associated with unfavorable clinical outcomes, as was the HDA score (OR = 1.35, 95% CI:1.19-1.54, p < 0.01). Including HDA indicators in the model significantly improved its unfavorable clinical outcome predictive power (AUC increased from 0.743 to 0.802; DeLong test; p < 0.01). The HDA score, which reflects the number of HDA involved regions, significantly correlated with unfavorable clinical outcomes and effectively predicted the prognosis. QuestionThe relationship between the location and extent of HDA on postoperative CT and hemorrhagic transformation and clinical outcomes in patients undergoing endovascular therapy is unclear. FindingsHemorrhagic transformation and unfavorable clinical outcomes were independently associated with the specific location of HDAs, and HDA score effectively predicted the prognosis. Clinical relevanceThe HDA score provided a simple quantitative measure that did not require specialized software. It significantly improved the prediction of unfavorable clinical outcomes and provided a risk stratification tool for patients after endovascular therapy.