To investigate the correlation between clot burden score (CBS) and hemorrhagic
transformation (HT) after endovascular therapy in patients with acute anterior circulation large vessel occlusion
stroke. Methods: A total of 111 patients diagnosed with acute anterior circulation large vessel occlusion stroke
who received endovascular therapy between January 2019 and December 2023 were retrospectively enrolled.
Patients were divided into HT group (45 cases) and non-HT group (66 cases) according to the presence or
absence of postoperative HT. Baseline data of the two groups were compared and analyzed. Binary Logistic
regression analysis was applied to explore the association between CBS and HT, and receiver operating
characteristic (ROC) curve analysis was performed to assess the predictive value. Results: Compared with the
non-HT group, the HT group presented significantly higher admission NIHSS score, elevated admission blood
glucose, longer time from symptom onset to femoral artery puncture, lower fibrinogen level, higher proportions
of patients with CBS≤5, preoperative intravenous thrombolysis, postoperative cerebral contrast extravasation
and coronary heart disease, with statistically significant differences. Binary Logistic regression analysis
identified that CBS≤5 (OR=5.04, 95% CI 1.41～18.06, P=0.013), high admission NIHSS score (OR=1.07,
95%CI 1.01～1.14, P=0.042), prolonged time from onset to femoral artery puncture (OR=1.01, 95%CI 1.000～
1.013, P=0.049) and postoperative contrast extravasation (OR=3.27, 95% CI 1.23～8.71, P=0.018) were
independent risk factors for HT after endovascular therapy in patients with acute anterior circulation large
vessel occlusion stroke. ROC curve analysis revealed that the area under the curve (AUC) of CBS for
predicting HT was 0.629; the AUC of the combined model (CBS plus admission NIHSS score,
onset-to-puncture time and postoperative cerebral contrast extravasation) reached 0.829. Conclusion: CBS≤
5 is an independent risk factor for postoperative HT in patients with acute anterior circulation large vessel
occlusion stroke treated with endovascular therapy.
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