The aim of this study was to evaluate the predictive value of the early venous filling (EVF) sign, the basal ganglia blush (BGB) sign and both the EVF and BGB signs for the hemorrhagic transformation (HT) and parenchymal hematoma (PH) in patients after endovascular thrombectomy.

This study included patients with anterior circulation large vessel occlusive stroke treated with endovascular thrombectomy from May 2017 to December 2021. The predictive value of regional circulation signs for HT and PH were assessed using logistic regression models adjusted for confounders, and further a multiplicative interaction term was added to investigate the effect of different stroke severity on its predictive value.

Among the 350 patients included and after adjusting for confounders, those with the EVF sign (adjusted OR=3.934, 95% CI:2.326–6.655), the BGB sign (adjusted OR=3.776, 95% CI:2.341–6.089), and both the EVF and BGB signs (adjusted OR=3.250, 95% CI: 1.886–5.600) were more likely to have HT. The EVF sign (adjusted OR=3.545, 95% CI:2.036–6.170), the BGB sign (adjusted OR=3.742, 95% CI:2.110–6.639), and both the EVF and BGB signs (adjusted OR=3.139, 95% CI: 1.776–5.549) were also significantly correlated with PH. When stratified according to stroke severity, we further found there were significant interactions between regional circulation signs and stroke severity on postoperative HT and PH (all P for interaction < 0.001).

Regional circulation signs were independently associated with HT and PH after endovascular thrombectomy and had a higher predictive value in patients with severe stroke compared with mild to moderate stroke.