Influence of Asymptomatic Hemorrhagic Transformation After Endovascular Treatment on Stroke Outcome
Bibliographic record
Abstract
BACKGROUND AND OBJECTIVES: In patients with acute ischemic stroke (AIS), the impact of hemorrhagic transformation (HT) after endovascular treatment (EVT) on poorer stroke outcome is well established when associated with clinical deterioration. However, the influence of asymptomatic HT remains unclear. We aimed to examine the impact of asymptomatic HT after EVT on functional outcome and mortality. METHODS: Drawing on Catalan (Spain) population-based prospective stroke registry data, we included patients from 10 comprehensive stroke centers with anterior circulation AIS (2017-2023) who underwent EVT, excluding patients without data on the presence of HT or functional outcome at 3 months of follow-up. HT was categorized as parenchymal hemorrhage (PH), hemorrhagic infarct (HI) types 1 and 2, and remote PH (rPH). Asymptomatic HT was defined as any HT not causing death or the NIH Stroke Scale (NIHSS) score to increase by ≥ 4 points. Functional outcome was centrally assessed using the modified Rankin Scale (mRS). The primary end point was a shift in the 3-month mRS score. After excluding symptomatic intracerebral hemorrhage (sICH), multivariable ordinal regression analyses (adjusted by age, mRS, baseline NIHSS score, baseline Alberta Stroke Program Early CT Score, and modified Thrombolysis In Cerebral Infarction score ≥2b) were performed to test for asymptomatic HT association with the primary end point. RESULTS: We included 3,067 patients (72.0 ± 13.6 years, 50.7% women), 179 (5.8%) with sICH and 612 (20.0%) with asymptomatic HT. HT category frequencies were 8.9% HI1, 7.2% HI2, 4.4% PH1, 3.8% PH2, and 1.5% rPH. The percentage of asymptomatic patients showed a hierarchical distribution, ranging from 93.4% in HI1 to 25.0% in PH2. In the multivariable analysis, asymptomatic HT was associated with poorer outcomes (common odds ratio [cOR] 2.24, 95% CI 1.89-2.66) and higher mortality (adjusted odds ratio 1.50, 95% CI 1.17-1.91). In the sensitivity analyses, the association with functional outcome remained significant for each HT category, with asymptomatic PH2 showing the highest odds of poorer outcomes (cOR 3.15, 95% CI 1.46-6.83). DISCUSSION: In patients with AIS undergoing EVT, asymptomatic HT was associated with poorer functional outcomes and higher mortality, suggesting that any HT, regardless of its clinical impact or radiologic category, should be considered as an additional EVT safety measure.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".