Correlation between impaired brachial flow-mediated dilation and hemorrhagic transformation after acute reperfusion therapy

Objective: Hemorrhagic transformation (HT) represents a critical complication of reperfusion therapy, often resulting in unfavorable functional outcomes. Our objective was to explore the correlation between endothelial function, assessed through flow-mediated dilation (FMD), and the occurrence of HT in patients undergoing acute reperfusion therapy.

Materials and methods: In our retrospective analysis, we investigated patients with emergent large vessel occlusion (ELVO) who underwent acute reperfusion therapy and assessment through FMD, calculated as %FMD = (peak diameter - baseline diameter)/baseline diameter×100. HT was categorized according to the European Cooperative Acute Stroke Study (ECASS) definition. Through multivariate analysis, we explored factors associated with HT, considering stroke mechanisms, and delved into the relationship between FMD and HT.

Results: A total of 172 patients were included in this study, with 45.3% experiencing HT. Factors associated with HT included high initial National Institute of Health Stroke Scale (NIHSS) scores [7 (5-10) vs. 10 (8-14); P <0.001], receiving tissue plasminogen activator (tPA) (21.3 vs. 39.7%; P<0.001), undergoing endovascular therapy (EVT) 10.6 vs. 26.9%; P <0.001), and impaired %FMD (6.2±2.5 vs. 4.9±1.8; P = 0.022). In a subgroup analysis of patients with cardioembolism, receiving EVT was significantly associated with HT (reference: tPA only; adjusted odds ratio [aOR] = 7.000; 95% confidence interval, 1.173-41.759; P = 0.033). In those with large artery atherosclerosis (LAA), a higher initial NIHSS score (aOR = 1.274; 1.082-1.499; P = 0.004) and impaired %FMD (aOR = 0.632; 0.402-0.995; P = 0.047) were independently associated with HT.

Conclusions: Endothelial dysfunction, indicated by impaired %FMD, emerges as a potential predictor of HT following acute reperfusion therapy, particularly in patients with LAA.