{
  "abstract": "Background The efficacy of mechanical thrombectomy (MT) for treating large infarcts has been established through multiple recent randomized controlled trials (RCTs). Nevertheless, hemorrhagic transformation (HT) remains one of the significant challenges following thrombectomy in these patients.Methods This study presents a post-hoc analysis of the Study of Endovascular Therapy in Acute Anterior Circulation Large Vessel Occlusive Patients with a Large Infarct Core (ANGEL-ASPECT) trial. We included all patients with large infarcts who underwent thrombectomy and had imaging data available for HT assessment. Multivariate regression models were developed to determine the predictive factors for post-thrombectomy parenchymal hemorrhage (PH) and examine the relationship between PH and patient outcomes.Results This study enrolled 217 patients, of whom 35 (16.1%) experienced PH 24–48 hours after thrombectomy. Multivariate analysis showed that patients with PH had a significantly worse functional outcome compared with patients without PH (modified Rankin Scale (mRS) score 5 vs 3, adjusted common OR (acOR) 0.31, 95% CI 0.16 to 0.61, P<0.01). Alcohol use (acOR 3.22, 95% CI 1.29 to 8.03, P=0.01) and an increased number of thrombectomy attempts (acOR 1.43, 95% CI 1.02 to 2.00, P=0.04) were independently associated with a heightened risk of PH. Conversely, local sedative anesthesia (acOR 0.10, 95% CI 0.01 to 0.84, P=0.03) was linked to a reduced risk of PH.Conclusions In patients with large infarcts, PH is associated with a poorer functional prognosis after thrombectomy. Alcohol use and a higher number of thrombectomy attempts were positively associated with the occurrence of PH, whereas local sedative anesthesia was negatively correlated with its occurrence.Trial registration number ClinicalTrials.gov Identifier: NCT04551664.",
  "authors": [
    {
      "affiliations": [
        "Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China",
        "China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Zhenbo Shi"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China",
        "China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Gang Luo"
    },
    {
      "affiliations": [
        "Cerebrovascular Disease Department, Neurological Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Xiaochuan Huo"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China",
        "China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Dapeng Sun"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China",
        "China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Yuesong Pan"
    },
    {
      "affiliations": [
        "China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Mengxing Wang"
    },
    {
      "affiliations": [
        "China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Tingfang Ai"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China",
        "China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Ligang Song"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China",
        "China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Xiaoqing Li"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China",
        "China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Baixue Jia"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China",
        "China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Bo Wang"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China",
        "China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Longhui Zhang"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China",
        "China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Fangguang Chen"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China",
        "China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Yiyang Sun"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China",
        "China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Dapeng Mo"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China",
        "China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Feng Gao"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China",
        "China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Ning Ma"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China",
        "China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Zhongrong Miao"
    },
    {
      "affiliations": [],
      "name": "for the ANGEL-ASPECT Study Group"
    }
  ],
  "title": "Predictors of parenchymal hemorrhage after endovascular treatment in large core ischemic stroke: a post-hoc analysis of the ANGEL-ASPECT trial",
  "uid": "5fa98a0c-f6c2-5b7b-bfd3-080dd8ba6455"
}