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Research Article: Analysis of risk factors for hemorrhagic transformation after mechanical thrombectomy in acute anterior circulation large vessel occlusion stroke and construction of a nomogram prediction model

Date Published: 2026-05-29

Abstract:
To identify risk factors for hemorrhagic transformation (HT) after mechanical thrombectomy (MT) in patients with acute anterior circulation large vessel occlusion (LVO) and to develop a predictive nomogram. This retrospective study enrolled 193 patients with acute anterior circulation LVO who underwent MT at a single center between January 2023 and December 2025. Patients were categorized into HT ( n =?45, 23.32%) and non-HT ( n =?148, 76.68%) groups based on postoperative imaging at 24–72?h. Univariate analysis was performed to compare baseline characteristics, biochemical indicators, and clinical variables between the two groups. Variables with p <?0.05 were subjected to Elastic Net regression with 10-fold cross-validation (StratifiedKFold) for variable selection and dimensionality reduction, with the optimal hyperparameters determined as C?=?1 and l1_ratio?=?0.9 (cross-validation AUC?=?0.8615). Eight variables were retained and subsequently entered into binary logistic regression with forward stepwise selection to identify independent risk factors and construct a prediction model. A nomogram was developed and evaluated using receiver operating characteristic (ROC) curve, calibration curve with bootstrap validation (1,000 resamples), and decision curve analysis (DCA). Six independent risk factors for HT were identified: history of alcohol consumption (OR?=?6.423, 95% CI 2.224–18.552, p =?0.001), history of leukoencephalopathy (OR?=?4.555, 95% CI 1.664–12.469, p =?0.003), elevated blood glucose-to-lymphocyte ratio (GLR) (OR?=?1.105, 95% CI 1.034–1.181, p =?0.003), elevated D-dimer (OR?=?1.102, 95% CI 1.029–1.180, p =?0.005), elevated venous blood glucose (OR?=?1.201, 95% CI 1.037–1.390, p =?0.014), and reduced mean platelet volume (MPV) (OR?=?0.704, 95% CI 0.537–0.925, p =?0.012). The nomogram demonstrated favorable discriminative ability with an AUC of 0.880 (95% CI 0.820–0.939), sensitivity of 0.933, and specificity of 0.696. Calibration curve analysis indicated good model fit (? 2 =?9.059, p =?0.337). Decision curve analysis revealed a net benefit rate > 0 when the threshold probability ranged from 0.01 to 0.97. History of alcohol consumption, leukoencephalopathy, elevated GLR, D-dimer, and venous blood glucose, and reduced MPV are independent risk factors for HT after MT in acute anterior circulation LVO stroke. The constructed nomogram exhibits good discrimination, calibration, and clinical utility, providing a reliable tool for individualized risk prediction.

Introduction:
Acute ischemic stroke (AIS) is a leading cause of disability and mortality worldwide. Among AIS cases, large vessel occlusion (LVO) accounts for 24–46% ( 1 , 2 ); owing to its severity and the suboptimal efficacy of intravenous thrombolysis, LVO-related stroke confers approximately twice the risk of death or functional dependency compared with non-LVO stroke ( 3 ). Endovascular therapy, with mechanical thrombectomy (MT) as its cornerstone, has achieved groundbreaking advances. Multiple randomized controlled trials…

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