Abstract Background and aims Hemorrhagic transformation (HT) is a common complication after mechanical thrombectomy in acute ischemic stroke (AIS), affecting 22-29% of patients. Conventional CT diagnosis is often delayed HT detection due to patient transfer. This systematic review and meta-analysis aimed to evaluate the diagnostic accuracy of intraprocedural flat-panel detector CT (FDCT) for early HT detection in AIS after endovascular therapy. Methods A systematic search of PubMed, Scopus, Web of Science, and Cochrane Library identified 18 studies evaluating the diagnostic performance of FDCT in AIS patients post-EVT. The analysis was conducted by RevMan with random-effects model and Egger’s test for bias. Results Analysis of 18 studies (3, 119 patients) showed a pooled FDCT detection rate for any HT of 41% (95% CI: 32–50%). Subgroup pooled analysis were: HI1 9% (95% CI: 2%–17%), HI2 17% (95% CI: 0–33%), PH1 11% (95% CI: 4–17%), and PH2 19% (95% CI: 3–35%). At 90 days, pooled mortality was 17% (95% CI: 12–23%) and functional independence (mRS 0–2) was 37% (95% CI: 26–47%). Heterogeneity was high (I²: 71. 2%–96. 6%). Leave-one-out analysis confirmed result stability. Egger’s test showed no bias for primary HT (p=0. 057) or mortality (p=0. 40), but indicated small-study effects for mRS 0–2 (p=0. 009) and PH2 (p=0. 042). Conclusions FDCT is an efficient intraprocedural tool for immediate post-thrombectomy assessment, identifying hemorrhagic transformation (HT) with high sensitivity which facilitates rapid clinical decision-making and optimizes post-procedural care. Conflict of interest Omar Elsayed Rageh: nothing to disclose, Toka Elboraay: nothing to disclose, Yehia Abdalla Abdalla: nothing to disclose, Elsayed S. Moubarak: nothing to disclose, mohamed wagdy: nothing to disclose
Elboraay et al. (2026) studied this question.