Analysis of Risk Factors for Hemorrhagic Transformation after Alteplase Intravenous Thrombolytic Bridging with Mechanical Thrombectomy in Acute Large Vessel Occlusive Stroke

doi:10.3877/cma.j.issn.2095-5782.2026.03.009

Abstract

Abstract:

Objective

To investigate the influencing factors of hemorrhagic transformation (HT) in patients with acute anterior circulation ischemic stroke after intravenous thrombolysis with alteplase combined with bridging mechanical thrombectomy.

Methods

Clinical data of 177 patients with acute anterior circulation ischemic stroke undergoing bridging therapy from November 2022 to July 2024 were retrospectively analyzed. Patients were divided into HT group (n=93) and non-HT group (n=84) according to the presence or absence of postoperative hemorrhage. Univariate and multivariate Logistic regression analyses were performed to identify independent risk factors for HT.

Results

The incidence of HT was 52.5% among 177 patients. Multivariate analysis showed that higher admission National Institutes of Health Stroke Scale (NIHSS) score and multiple thrombectomy passes were independent risk factors for postoperative HT (P<0.05). For prognosis, the 90-day favorable prognosis rate (modified Rankin Scale score ≤2) was significantly lower in HT group than in non-HT group (43.0% vs. 58.3%, P<0.05).

Conclusion

High baseline NIHSS score on admission and multiple thrombectomy passes are independent risk factors for HT in acute anterior circulation ischemic stroke patients after bridging therapy.

Key words: Acute ischemic stroke, Hemorrhagic transformation, Bridging therapy, Influencing factor, Clinical prognosis

Xiaohui Li, Yu Hang, Xuan Wang, Zhenyu Jia, Lina Mao, Longquan Dai, Haibin Shi, Li Ji. Analysis of Risk Factors for Hemorrhagic Transformation after Alteplase Intravenous Thrombolytic Bridging with Mechanical Thrombectomy in Acute Large Vessel Occlusive Stroke[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2026, 14(03): 286-291.

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URL: https://zhjrfsxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-5782.2026.03.009

https://zhjrfsxdzzz.cma-cmc.com.cn/EN/Y2026/V14/I03/286

Figures/Tables 2

基本资料	非HT组(84例)	HT组(93例)	P值
年龄(岁， $x ¯$ ±s)	66.86±11.71	68.56±12.37	0.350
性别[例(%)]			0.103
男性	57(67.90)	52(55.90)
女性	27(32.10)	41(44.10)
高血压[例(%)]			0.192
否	36(42.90)	31(33.30)
是	48(57.10)	62(66.70)
冠心病[例(%)]			0.436
否	69(82.10)	72(77.40)
是	15(17.90)	21(22.60)
房颤[例(%)]			0.479
否	48(57.10)	58(62.40)
是	36(42.90)	35(37.60)
糖尿病[例(%)]			0.073
否	70(83.30)	67(72.00)
是	14(16.70)	26(28.00)
吸烟史[例(%)]			0.464
否	62(73.80)	73(78.50)
是	22(26.20)	20(21.50)
入院NIHSS评分(分， $x ¯$ ±s)	15.92±6.07	18.05±7.19	0.035^*
入院ASPECTS评分[分，M(Q₁,Q₃)]	8(10,7)	7(9,6)	0.450
静脉溶栓剂量(mg， $x ¯$ ±s)	49.51±14.75	52.99±14.06	0.110
发病至溶栓时间(min， $x ¯$ ±s)	158.75±65.27	160.01±65.29	0.898
发病至股动脉穿刺时间[min，M(Q₁,Q₃)]	247.00(194.25,293.75)	264.00(212.00,325.50)	0.185
发病至再通时间(min， $x ¯$ ±s)	343.17±118.80	395.41±197.87	0.037^*
核心梗死体积[mL，M(Q₁,Q₃)]	14.50(8.75,20.50)	18.75(10.50,26.50)	0.500
取栓次数[次，M(Q₁,Q₃)]	1(1,2)	2(1,3)	0.005^*
闭塞部位[例(%)]			0.121
ICA	19(22.60)	31(33.30)
MCA M1	57(67.90)	49(52.70)
ICA+M1	8(9.50)	13(14.00)
TOAST分型[例(%)]			0.470
LAA	35(41.70)	36(38.70)
CE	46(54.80)	56(60.20)
其他	3(3.60)	1(1.10)
成功再通[例(%)]
否	10(11.90)	12(12.90)	0.841
是	74(88.10)	81(87.10)	0.841
大面积脑梗死[例(%)]			0.050
否	67(79.80)	62(66.70)
是	17(20.20)	31(33.30)
sICH[例(%)]	/	10(10.80)
HI-1[例(%)]	/	42(45.20)
HI-2[例(%)]	/	5(5.40)
PH-1[例(%)]	/	36(38.70)
PH-2[例(%)]	/	10(10.80)
90 d预后[例(%)]			0.042^*
良好	49(58.30)	40(43.00)
不佳	35(41.70)	53(57.00)
90 d病死率[例(%)]	6(7.10)	15(16.10)	0.065

基本资料	非HT组(84例)	HT组(93例)	P值
年龄(岁， $x ¯$ ±s)	66.86±11.71	68.56±12.37	0.350
性别[例(%)]			0.103
男性	57(67.90)	52(55.90)
女性	27(32.10)	41(44.10)
高血压[例(%)]			0.192
否	36(42.90)	31(33.30)
是	48(57.10)	62(66.70)
冠心病[例(%)]			0.436
否	69(82.10)	72(77.40)
是	15(17.90)	21(22.60)
房颤[例(%)]			0.479
否	48(57.10)	58(62.40)
是	36(42.90)	35(37.60)
糖尿病[例(%)]			0.073
否	70(83.30)	67(72.00)
是	14(16.70)	26(28.00)
吸烟史[例(%)]			0.464
否	62(73.80)	73(78.50)
是	22(26.20)	20(21.50)
入院NIHSS评分(分， $x ¯$ ±s)	15.92±6.07	18.05±7.19	0.035^*
入院ASPECTS评分[分，M(Q₁,Q₃)]	8(10,7)	7(9,6)	0.450
静脉溶栓剂量(mg， $x ¯$ ±s)	49.51±14.75	52.99±14.06	0.110
发病至溶栓时间(min， $x ¯$ ±s)	158.75±65.27	160.01±65.29	0.898
发病至股动脉穿刺时间[min，M(Q₁,Q₃)]	247.00(194.25,293.75)	264.00(212.00,325.50)	0.185
发病至再通时间(min， $x ¯$ ±s)	343.17±118.80	395.41±197.87	0.037^*
核心梗死体积[mL，M(Q₁,Q₃)]	14.50(8.75,20.50)	18.75(10.50,26.50)	0.500
取栓次数[次，M(Q₁,Q₃)]	1(1,2)	2(1,3)	0.005^*
闭塞部位[例(%)]			0.121
ICA	19(22.60)	31(33.30)
MCA M1	57(67.90)	49(52.70)
ICA+M1	8(9.50)	13(14.00)
TOAST分型[例(%)]			0.470
LAA	35(41.70)	36(38.70)
CE	46(54.80)	56(60.20)
其他	3(3.60)	1(1.10)
成功再通[例(%)]
否	10(11.90)	12(12.90)	0.841
是	74(88.10)	81(87.10)	0.841
大面积脑梗死[例(%)]			0.050
否	67(79.80)	62(66.70)
是	17(20.20)	31(33.30)
sICH[例(%)]	/	10(10.80)
HI-1[例(%)]	/	42(45.20)
HI-2[例(%)]	/	5(5.40)
PH-1[例(%)]	/	36(38.70)
PH-2[例(%)]	/	10(10.80)
90 d预后[例(%)]			0.042^*
良好	49(58.30)	40(43.00)
不佳	35(41.70)	53(57.00)
90 d病死率[例(%)]	6(7.10)	15(16.10)	0.065

变量	分析类型	B值	标准误	Wald值	OR（95% CI）	P值
发病至再通时间	单因素	0.002	0.001	3.871	1.002(1.000~1.005)	0.049
发病至再通时间	多因素	0.002	0.001	3.386	1.002(1.000~1.004)	0.066
取栓次数	单因素	0.323	0.121	7.158	1.381(1.090~1.750)	0.007
取栓次数	多因素	0.285	0.126	5.123	1.330(1.039~1.702)	0.024
入院NIHSS评分	单因素	0.049	0.023	4.337	1.050(1.003~1.099)	0.037
入院NIHSS评分	多因素	0.048	0.024	3.926	1.049(1.001~1.100)	0.048

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