Perioperative Liver Function Parameters as Potential Predictors o f Hemorrhagic Transformation in Acute Ischemic Stroke Patients with Successful Recanalization after Endovascular Treatment: A Retrospective Cohort Study

INTRODUCTION: Acute ischemic stroke (AIS) is a leading global cause of death/ disability; endovascular thrombectomy (EVT) treats large vessel occlusion, but postrecanalization hemorrhagic transformation (HT) raises mortality/poor outcomes. Established HT risk factors lack specificity, and the perioperative liver function parameters' predictive role is underexplored. This study investigated their association in AIS patients with successful EVT recanalization. MATERIALS AND METHODS: Retrospective single-center cohort included AIS patients with EVT success [modified Thrombolysis in Cerebral Infarction (mTICI) 2b/3], aged ≥18, AIS confirmed by CT/MRI, and pre-/24h post-op liver tests. EXCLUSIONS: non-AIS, intra-arterial thrombolysis, failed recanalization, and missing liver data. VARIABLES: demographics, National Institutes of Health Stroke Scale (NIHSS)/ modified Rankin Scale (mRS), liver parameters [aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyltransferase (GGT)]. Univariate/multivariate logistic regression (IBM SPSS 23) analyzed CT-confirmed HT. RESULTS: Of 178 initial patients, 138 were included (85 non-HT, 53 HT). Univariate: preoperative AST/ALT ratio (OR = 2.547, p = 0.020) was significantly correlated with HT. Multivariate: postoperative AST (OR = 1.427, p = 0.012) and bidirectional GGT (pre-op elevation reduced HT: OR = 0.850, p = 0.010; post-op elevation increased HT: OR = 1.215, p = 0.009) were independent predictors. Model efficacy: Area under the curve (AUC) = 0.869, 84.1% correct prediction. CONCLUSION: Perioperative AST and GGT are novel HT predictors. Postoperative AST elevation and dynamic GGT changes highlight the value of routine liver monitoring. Future research needs mechanistic validation and multicenter studies.