ORIGINAL RESEARCH article
Front. Neurol.
Sec. Endovascular and Interventional Neurology
Differential Impact of Deep Intraparenchymal Hyperdensities versus Subarachnoid/Cortical Hyperdensities on Futile Reperfusion After Mechanical Thrombectomy: A Propensity Score-Matched Study
Provisionally accepted
- 1The Affiliated Huaian NO.1 People′s Hospital of Nanjing Medical University, Huaian, China
- 2Shandong University of Traditional Chinese Medicine, Jinan, China
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Background: Despite successful mechanical thrombectomy (MT), futile reperfusion (FR) remains a major challenge in acute ischemic stroke (AIS). While post-MT hyperdense areas (HDAs) on non-contrast CT are associated with reperfusion injury, the differential effects of anatomical HDA subtypes—deep intraparenchymal (DIH) versus subarachnoid/cortical (SCH)—on FR risk are unclear. Methods: We retrospectively analyzed 864 AIS patients undergoing MT (2017-2023). HDAs detected within 0.5 hours post-MT were classified as DIH or SCH. Propensity score matching (PSM) balanced baseline confounders (1:1 DIH:SCH). Risk factors for FR were analyzed by multivariate logistic regression analysis in the PSM cohort. Results: After PSM, 116 patients in the DIH group were matched with 116 patients in the SCH group. 91 patients (78.5%) in the SCH group and 72 patients (62.1%) in the DIH group suffered FR (P=0.006). Multivariate analysis showed that SCH significantly increased the risk of FR (OR 3.103, 95%CI 1.425-6.759, P=0.004), indicating that patients with SCH have a 3.103 times higher risk of FR than patients with DIH. Conclusions: Anatomical HDAs subtypes differentially predict FR risk, with SCH portending worse prognosis. This subtype classification enables early risk stratification and may guide personalized post-MT management.
Keywords: Acute ischemic stroke, Mechanical thrombectomy, Futile reperfusion, deepintraparenchymal hyperdensities, subarachnoid/cortical hyperdensities
Received: 16 Aug 2025; Accepted: 28 Nov 2025.
Copyright: © 2025 Dong, Wang, Sun, Zhou, An and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Kun An
Mingchao Li
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