Baseline ASPECTS, Fibrinogen Level, and Platelet Count for Predicting Hemorrhagic Transformation After Mechanical Thrombectomy in Acute Ischemic Stroke

Background: Hemorrhagic transformation (HT) is a major complication after mechanical thrombectomy (MT) in acute ischemic stroke (AIS). This study evaluated the predictive value of baseline ASPECTS, fibrinogen level, and platelet count for HT after MT. Methods: We retrospectively analyzed 274 AIS patients treated with MT. HT within 24 h was identified using follow-up imaging. Logistic regression, ROC analysis, DeLong tests, and bootstrap resampling (1000 iterations) were performed to evaluate predictors and model performance. Results: HT occurred in 52/274 patients (19.0%). Baseline ASPECTS (adjusted OR 0.73, 95% CI 0.61–0.88; p = 0.001), fibrinogen level (adjusted OR 0.51, 95% CI 0.32–0.79; p = 0.003), and platelet count (adjusted OR 0.99, 95% CI 0.99–1.00; p = 0.018) were independently associated with HT. Baseline ASPECTS showed the highest discriminative ability among individual predictors (AUC = 0.684), whereas baseline NIHSS score showed poor performance (AUC = 0.539). The reduced model combining baseline ASPECTS score, fibrinogen level, and platelet count achieved a balanced discriminative performance (AUC = 0.739), with no significant difference compared with the full model (p = 0.804) or baseline ASPECTS alone (p = 0.112). Similarly, the full model did not significantly outperform baseline ASPECTS (p = 0.120). Bootstrap validation confirmed model stability. Conclusions: Baseline ASPECTS, fibrinogen level, and platelet count are independent predictors of HT after MT. A reduced model incorporating these variables demonstrated modest-to-acceptable and parsimonious predictive performance, although external validation is required before clinical implementation.