ArticleFrontiers in medicine2026
Dual-phase CTA filling pattern is associated with reperfusion-related complications after mechanical thrombectomy in late-window anterior circulation stroke.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To evaluate whether pre-treatment dual-phase computed tomography angiography (CTA) filling patterns are independently associated with reperfusion-related complications after late-window mechanical thrombectomy and whether they provide incremental prognostic value beyond conventional clinical and imaging variables. Methods: We conducted a prospective single-center cohort study including 80 consecutive patients with anterior circulation large-vessel occlusion who underwent mechanical thrombectomy within 6-24 h after stroke onset or last known well. Dual-phase CTA filling patterns were classified as good early filling, delayed filling, or persistent poor filling; delayed and persistent poor filling were combined for the primary analyses. The primary outcome was a composite of reperfusion-related complications within 72 h, including hemorrhagic transformation ≥HI2, malignant cerebral edema, or early neurological deterioration. Secondary outcomes were 90-day functional independence and all-cause mortality. Independent predictors were identified using Firth penalized logistic regression. Incremental model performance was evaluated using receiver operating characteristic analysis, bootstrap internal validation, reclassification metrics, and decision-curve analysis. Results: Reperfusion-related complications occurred in 28 patients (35%) and were significantly more frequent in patients with delayed or poor filling than in those with good early filling (56% vs. 20%; Conclusions: Delayed or persistent poor filling on dual-phase CTA is an independent imaging marker of reperfusion-related complications following late-window mechanical thrombectomy. Although its incremental contribution to model discrimination was modest, dual-phase CTA may improve early risk stratification and help identify patients who may benefit from intensified post-procedural monitoring. External validation is warranted before routine clinical implementation.
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