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Peer-reviewedCC BY 4.0Frontiers in Neurology

Early postoperative ipsilateral middle cerebral artery pulsatility index is associated with cerebral hemorrhage after endovascular treatment in anterior circulation large vessel occlusion

  • Wensheng Zhang1,2
  • Weiwei Liu1
  • Jumei Zhu1
  • Weifang Xing1
  • Guiping Yang1
  • Hongli Gu1
  • Yunqiang Huang1
  • Minzhen Zhu1
  • Wenjie Zi3
  • Xiaojing Zhong1
  • Guanghong Zhong1
  • Zhenqin Jiang1
  1. 1Department of Neurology, Heyuan People’s Hospital, Guangdong Provincial People’s Hospital Heyuan Hospital
  2. 2Heyuan Key Laboratory of Molecular Diagnosis & Disease Prevention and Treatment, Doctors Station of Guangdong Province, Heyuan People’s Hospital
  3. 3Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University)
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Abstract

Objective: To investigate the predictive value of the early postoperative ipsilateral middle cerebral artery pulsatility index (PI) for cerebral hemorrhage after endovascular treatment in patients with anterior circulation large vessel occlusion acute ischemic stroke.

Methods: A total of 120 patients were divided into a cerebral hemorrhage group ( n = 17) and a non-hemorrhage group ( n = 103). Multivariable logistic regression and Firth penalized likelihood regression were used to identify independent predictors. Receiver operating characteristic (ROC) curves evaluated the predictive performance of individual indicators and a combined model. Bootstrap resampling (1,000 iterations) was performed for internal validation.

Results: Multivariable logistic regression showed that diabetes mellitus (OR = 4.154, 95% CI: 1.255–13.756, p = 0.020), ASPECTS >8 (OR = 0.115, 95% CI: 0.014–0.942, p = 0.044), and elevated ipsilateral PI (OR = 11.355, 95% CI: 1.267–101.761, p = 0.030) were associated with cerebral hemorrhage. Firth regression confirmed these results. The ipsilateral PI predicted cerebral hemorrhage with an AUC of 0.716 (95% CI: 0.597–0.835), an optimal cutoff of 0.735, a sensitivity of 0.882, and a specificity of 0.505. The combined model (diabetes, ASPECTS >8, PI) achieved an AUC of 0.808 (95% CI: 0.718–0.899), with a sensitivity of 0.882 and a specificity of 0.650. Bootstrap internal validation showed a bias-corrected AUC of 0.810 (95% CI: 0.717–0.896) and an optimism of −0.0022.

Conclusion: The early postoperative ipsilateral middle cerebral artery PI is a potential prognostic marker for any radiographic intracranial hemorrhage after endovascular treatment in anterior circulation large vessel occlusion acute ischemic stroke, with an optimal cutoff of 0.735. In this cohort, adding PI to diabetes mellitus and ASPECTS was associated with a modest improvement in discrimination (ΔAUC = 0.088, p = 0.011) and continuous net reclassification improvement (NRI = 0.594, p = 0.020), whereas categorical NRI was not significant. These findings are exploratory and require validation in larger cohorts.

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Cite

BibTeXRIS
BibTeX
@article{zhang2026early,
  title = {{Early postoperative ipsilateral middle cerebral artery pulsatility index is associated with cerebral hemorrhage after endovascular treatment in anterior circulation large vessel occlusion}},
  author = {Wensheng Zhang and Weiwei Liu and Jumei Zhu and Weifang Xing and Guiping Yang and Hongli Gu and Yunqiang Huang and Minzhen Zhu and Wenjie Zi and Xiaojing Zhong and Guanghong Zhong and Zhenqin Jiang},
  journal = {Frontiers in Neurology},
  year = {2026},
  month = oct,
  doi = {10.3389/fneur.2026.1972755},
  url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1972755/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Early postoperative ipsilateral middle cerebral artery pulsatility index is associated with cerebral hemorrhage after endovascular treatment in anterior circulation large vessel occlusion
AU  - Wensheng Zhang
AU  - Weiwei Liu
AU  - Jumei Zhu
AU  - Weifang Xing
AU  - Guiping Yang
AU  - Hongli Gu
AU  - Yunqiang Huang
AU  - Minzhen Zhu
AU  - Wenjie Zi
AU  - Xiaojing Zhong
AU  - Guanghong Zhong
AU  - Zhenqin Jiang
PY  - 2026
DA  - 2026/10/26
JO  - Frontiers in Neurology
DO  - 10.3389/fneur.2026.1972755
UR  - https://www.frontiersin.org/articles/10.3389/fneur.2026.1972755/full
AB  - Objective: To investigate the predictive value of the early postoperative ipsilateral middle cerebral artery pulsatility index (PI) for cerebral hemorrhage after endovascular treatment in patients with anterior circulation large vessel occlusion acute ischemic stroke.  Methods: A total of 120 patients were divided into a cerebral hemorrhage group ( n = 17) and a non-hemorrhage group ( n = 103). Multivariable logistic regression and Firth penalized likelihood regression were used to identify independent predictors. Receiver operating characteristic (ROC) curves evaluated the predictive performance of individual indicators and a combined model. Bootstrap resampling (1,000 iterations) was performed for internal validation.  Results: Multivariable logistic regression showed that diabetes mellitus (OR = 4.154, 95% CI: 1.255–13.756, p = 0.020), ASPECTS >8 (OR = 0.115, 95% CI: 0.014–0.942, p = 0.044), and elevated ipsilateral PI (OR = 11.355, 95% CI: 1.267–101.761, p = 0.030) were associated with cerebral hemorrhage. Firth regression confirmed these results. The ipsilateral PI predicted cerebral hemorrhage with an AUC of 0.716 (95% CI: 0.597–0.835), an optimal cutoff of 0.735, a sensitivity of 0.882, and a specificity of 0.505. The combined model (diabetes, ASPECTS >8, PI) achieved an AUC of 0.808 (95% CI: 0.718–0.899), with a sensitivity of 0.882 and a specificity of 0.650. Bootstrap internal validation showed a bias-corrected AUC of 0.810 (95% CI: 0.717–0.896) and an optimism of −0.0022.  Conclusion: The early postoperative ipsilateral middle cerebral artery PI is a potential prognostic marker for any radiographic intracranial hemorrhage after endovascular treatment in anterior circulation large vessel occlusion acute ischemic stroke, with an optimal cutoff of 0.735. In this cohort, adding PI to diabetes mellitus and ASPECTS was associated with a modest improvement in discrimination (ΔAUC = 0.088, p = 0.011) and continuous net reclassification improvement (NRI = 0.594, p = 0.020), whereas categorical NRI was not significant. These findings are exploratory and require validation in larger cohorts.
SN  - 1664-2295
ER  -