Associated Factors of Hemorrhagic Transformation in Patients Undergoing Anterior Circulation Thrombectomy: Data from a Comprehensive Stroke Center in Vietnam

Background/Objectives: Hemorrhagic transformation (HT) is a common complication after mechanical thrombectomy. This study aimed to determine the incidence of and factors associated with HT, evaluate factors associated with sICH, and assess prognostic factors associated with 90-day functional outcome after anterior-circulation thrombectomy. Methods: We retrospectively analyzed 244 consecutive patients with acute ischemic stroke who underwent anterior circulation thrombectomy between June 2022 and May 2023. Clinical, laboratory, imaging, and treatment variables were compared according to HT, sICH, and 90-day functional outcome. Univariate and multivariable logistic regression analyses were performed. Results: HT and sICH occurred in 38.5% and 10.0% of patients, respectively. Cardioembolic etiology was independently associated with HT (adjusted odds ratio [aOR] 2.39, 95% confidence interval [CI] 1.31–4.36) and sICH (aOR 2.79, 95% CI 1.12–6.93). Successful reperfusion (TICI 2b–3) was independently associated with HT (aOR 2.51, 95% CI 1.09–5.77). Among patients with HT, younger age (aOR 0.86, 95% CI 0.78–0.95) and a lower 24-h National Institutes of Health Stroke Scale score (aOR 0.62, 95% CI 0.43–0.88) were independently associated with good functional outcome at 90 days. Conclusions: Cardioembolic etiology and successful recanalization were independently associated with HT, whereas cardioembolic etiology was independently associated with sICH. Among patients with HT, younger age and a lower 24-h neurological deficit were prognostic markers of better functional outcomes.