Dual-phase CTA filling pattern is associated with reperfusion-related complications after mechanical thrombectomy in late-window anterior circulation stroke.
- 1Department of Neurovascular Intervention, Institute of Neurology, 108 Military Central Hospital, Hanoi, Vietnam.
- 2Department of Stroke, Institute of Neurology, 108 Military Central Hospital, Hanoi, Vietnam.
Abstract
Objective
To evaluate whether pre-treatment dual-phase computed tomography angiography (CTA) filling patterns are independently associated with reperfusion-related complications after late-window mechanical thrombectomy and whether they provide incremental prognostic value beyond conventional clinical and imaging variables.Methods
We conducted a prospective single-center cohort study including 80 consecutive patients with anterior circulation large-vessel occlusion who underwent mechanical thrombectomy within 6-24 h after stroke onset or last known well. Dual-phase CTA filling patterns were classified as good early filling, delayed filling, or persistent poor filling; delayed and persistent poor filling were combined for the primary analyses. The primary outcome was a composite of reperfusion-related complications within 72 h, including hemorrhagic transformation ≥HI2, malignant cerebral edema, or early neurological deterioration. Secondary outcomes were 90-day functional independence and all-cause mortality. Independent predictors were identified using Firth penalized logistic regression. Incremental model performance was evaluated using receiver operating characteristic analysis, bootstrap internal validation, reclassification metrics, and decision-curve analysis.Results
Reperfusion-related complications occurred in 28 patients (35%) and were significantly more frequent in patients with delayed or poor filling than in those with good early filling (56% vs. 20%; p < 0.001). Delayed or poor filling independently predicted reperfusion-related complications after adjustment for age, baseline NIHSS score, and ASPECTS (adjusted OR 3.97, 95% CI 1.22-14.10; p = 0.022). Older age was also independently associated with increased risk (adjusted OR 2.14 per 10-year increase, 95% CI 1.24-4.12; p = 0.005), whereas higher ASPECTS was protective (adjusted OR 0.35 per point, 95% CI 0.18-0.61; p < 0.001). The full model incorporating dual-phase CTA achieved excellent discrimination (AUC 0.895; optimism-corrected AUC 0.867). Addition of the dual-phase CTA filling pattern improved patient risk reclassification, although the increase in discrimination beyond the clinical-plus-ASPECTS model was not statistically significant. Patients with delayed or poor filling had substantially worse 90-day outcomes, including lower functional independence (24% vs. 70%) and higher mortality (38% vs. 4%) (both p < 0.001).Conclusions
Delayed or persistent poor filling on dual-phase CTA is an independent imaging marker of reperfusion-related complications following late-window mechanical thrombectomy. Although its incremental contribution to model discrimination was modest, dual-phase CTA may improve early risk stratification and help identify patients who may benefit from intensified post-procedural monitoring. External validation is warranted before routine clinical implementation.
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BibTeX
@article{le2026dualphase,
title = {{Dual-phase CTA filling pattern is associated with reperfusion-related complications after mechanical thrombectomy in late-window anterior circulation stroke.}},
author = {Truong Van Le and Khanh T Ngoc Thach and Tuyen Trong Nguyen and Ha Hai T Dinh},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1934591},
url = {https://europepmc.org/article/MED/42909051},
note = {CC BY},
}
RIS
TY - JOUR
TI - Dual-phase CTA filling pattern is associated with reperfusion-related complications after mechanical thrombectomy in late-window anterior circulation stroke.
AU - Truong Van Le
AU - Khanh T Ngoc Thach
AU - Tuyen Trong Nguyen
AU - Ha Hai T Dinh
PY - 2026
DA - 2026/10/07
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1934591
UR - https://europepmc.org/article/MED/42909051
AB - Objective To evaluate whether pre-treatment dual-phase computed tomography angiography (CTA) filling patterns are independently associated with reperfusion-related complications after late-window mechanical thrombectomy and whether they provide incremental prognostic value beyond conventional clinical and imaging variables.Methods We conducted a prospective single-center cohort study including 80 consecutive patients with anterior circulation large-vessel occlusion who underwent mechanical thrombectomy within 6-24 h after stroke onset or last known well. Dual-phase CTA filling patterns were classified as good early filling, delayed filling, or persistent poor filling; delayed and persistent poor filling were combined for the primary analyses. The primary outcome was a composite of reperfusion-related complications within 72 h, including hemorrhagic transformation ≥HI2, malignant cerebral edema, or early neurological deterioration. Secondary outcomes were 90-day functional independence and all-cause mortality. Independent predictors were identified using Firth penalized logistic regression. Incremental model performance was evaluated using receiver operating characteristic analysis, bootstrap internal validation, reclassification metrics, and decision-curve analysis.Results Reperfusion-related complications occurred in 28 patients (35%) and were significantly more frequent in patients with delayed or poor filling than in those with good early filling (56% vs. 20%; p < 0.001). Delayed or poor filling independently predicted reperfusion-related complications after adjustment for age, baseline NIHSS score, and ASPECTS (adjusted OR 3.97, 95% CI 1.22-14.10; p = 0.022). Older age was also independently associated with increased risk (adjusted OR 2.14 per 10-year increase, 95% CI 1.24-4.12; p = 0.005), whereas higher ASPECTS was protective (adjusted OR 0.35 per point, 95% CI 0.18-0.61; p < 0.001). The full model incorporating dual-phase CTA achieved excellent discrimination (AUC 0.895; optimism-corrected AUC 0.867). Addition of the dual-phase CTA filling pattern improved patient risk reclassification, although the increase in discrimination beyond the clinical-plus-ASPECTS model was not statistically significant. Patients with delayed or poor filling had substantially worse 90-day outcomes, including lower functional independence (24% vs. 70%) and higher mortality (38% vs. 4%) (both p < 0.001).Conclusions Delayed or persistent poor filling on dual-phase CTA is an independent imaging marker of reperfusion-related complications following late-window mechanical thrombectomy. Although its incremental contribution to model discrimination was modest, dual-phase CTA may improve early risk stratification and help identify patients who may benefit from intensified post-procedural monitoring. External validation is warranted before routine clinical implementation.
SN - 2296-858X
ER -