To evaluate the predictive value of baseline serum caveolin-1 (Cav-1) level for hemorrhagic transformation (HT) after bridging therapy in patients with anterior circulation large vessel occlusion.

Patients with anterior circulation large vessel occlusion who underwent bridging therapy at the First Hospital of Qiqihar from January 2022 to December 2024 were enrolled. They were divided into the hemorrhagic group (n=26) and non-hemorrhagic group (n=52) according to the presence of HT. Clinical data of the two groups were collected, including general information, cranial imaging findings, laboratory indicators, and baseline serum Cav-1 level. We analyzed whether baseline Cav-1 level could serve as an independent predictor of HT after bridging therapy. Additionally, the impact of baseline serum Cav-1 level on prognosis was evaluated based on whether the modified Rankin scale (mRS) score was ≤2 at 3 months and the mortality status of patients. The differences of measurement data were analyzed using independent sample t-test or Mann-Whitney U test. The Logistic analysis was used to identify the independent factors influencing intracranial HT, and the receiver operator characteristic (ROC) curve was plotted.

The hemorrhagic group had higher random blood glucose [8.28 (6.34, 10.99) mmol/L vs 6.22 (5.46, 8.28) mmol/L, Z=-2.459, P=0.014], lower baseline Cav-1 [109.50 (103.75, 117.25) ng/L vs 117.00 (111.50, 127.75) ng/L, Z=2.487, P=0.020], lower ASPECTS [8.00 (7.00, 10.00) vs 9.00 (8.00, 10.00), Z=-2.600, P=0.009], and higher National Institute of Health stroke scale (NIHSS) scores (15.65±2.62 vs 13.92±3.26, t=2.352, P=0.021). Multivariate analysis showed that baseline serum Cav-1 level (OR=0.90, 95%CI: 0.84-0.97, P=0.006), ASPECTS (OR=0.56, 95%CI: 0.33-0.92, P=0.022), NIHSS score (OR=1.34, 95%CI: 1.06-1.69, P=0.013), and systolic blood pressure (OR=1.03, 95%CI: 1.01-1.06, P=0.018) were all independent influencing factors for HT after bridging therapy in patients with anterior circulation large vessel occlusion. Results of the ROC curve indicated that the area under the curve (AUC) of the nomogram prediction model based on baseline serum Cav-1 level was the largest, at 0.71 (95%CI: 0.60-0.82). Higher baseline Cav-1 was associated with good prognosis [118.50 (111.00, 129.00) ng/L vs 113.00 (104.00, 117.00) ng/L, Z=-2.852, P=0.004] but not with mortality [114.00 (106.00, 116.50) ng/L vs 116.00 (108.00, 123.50) ng/L, Z=-1.127, P=0.260].

In the hemorrhagic group, baseline serum Cav-1 level and ASPECTS score were lower while NIHSS score and systolic blood pressure were higher; a low baseline serum Cav-1 level could predict HT after bridging therapy, while a high baseline serum Cav-1 level is associated with better prognosis at 3 months, without significant impact on mortality.