Background and Purpose - As a reliable scoring system to detect the risk of symptomatic intracerebral hemorrhage after thrombectomy for ischemic stroke is not yet available, we developed a nomogram for predicting symptomatic intracerebral hemorrhage in patients with large vessel occlusion in the anterior circulation who received bridging of thrombectomy with intravenous thrombolysis (training set), and to validate the model by using a cohort of patients treated with direct thrombectomy (test set). Methods - We conducted a cohort study on prospectively collected data from 3714 patients enrolled in the IER (Italian Registry of Endovascular Stroke Treatment in Acute Stroke). Symptomatic intracerebral hemorrhage was defined as any type of intracerebral hemorrhage with increase of ≥4 National Institutes of Health Stroke Scale score points from baseline ≤24 hours or death. Based on multivariate logistic models, the nomogram was generated. We assessed the discriminative performance by using the area under the receiver operating characteristic curve. Results - National Institutes of Health Stroke Scale score, onset-to-end procedure time, age, unsuccessful recanalization, and Careggi collateral score composed the IER-SICH nomogram. After removing Careggi collateral score from the first model, a second model including Alberta Stroke Program Early CT Score was developed. The area under the receiver operating characteristic curve of the IER-SICH nomogram was 0.778 in the training set (n=492) and 0.709 in the test set (n=399). The area under the receiver operating characteristic curve of the second model was 0.733 in the training set (n=988) and 0.685 in the test set (n=779). Conclusions - The IER-SICH nomogram is the first model developed and validated for predicting symptomatic intracerebral hemorrhage after thrombectomy. It may provide indications on early identification of patients for more or less postprocedural intensive management.

IER-SICH Nomogram to Predict Symptomatic Intracerebral Hemorrhage After Thrombectomy for Stroke

Bergui M.;Lafe E.;Petruzzellis M.;Carolei A.;Tassinari T.;
2019

Abstract

Background and Purpose - As a reliable scoring system to detect the risk of symptomatic intracerebral hemorrhage after thrombectomy for ischemic stroke is not yet available, we developed a nomogram for predicting symptomatic intracerebral hemorrhage in patients with large vessel occlusion in the anterior circulation who received bridging of thrombectomy with intravenous thrombolysis (training set), and to validate the model by using a cohort of patients treated with direct thrombectomy (test set). Methods - We conducted a cohort study on prospectively collected data from 3714 patients enrolled in the IER (Italian Registry of Endovascular Stroke Treatment in Acute Stroke). Symptomatic intracerebral hemorrhage was defined as any type of intracerebral hemorrhage with increase of ≥4 National Institutes of Health Stroke Scale score points from baseline ≤24 hours or death. Based on multivariate logistic models, the nomogram was generated. We assessed the discriminative performance by using the area under the receiver operating characteristic curve. Results - National Institutes of Health Stroke Scale score, onset-to-end procedure time, age, unsuccessful recanalization, and Careggi collateral score composed the IER-SICH nomogram. After removing Careggi collateral score from the first model, a second model including Alberta Stroke Program Early CT Score was developed. The area under the receiver operating characteristic curve of the IER-SICH nomogram was 0.778 in the training set (n=492) and 0.709 in the test set (n=399). The area under the receiver operating characteristic curve of the second model was 0.733 in the training set (n=988) and 0.685 in the test set (n=779). Conclusions - The IER-SICH nomogram is the first model developed and validated for predicting symptomatic intracerebral hemorrhage after thrombectomy. It may provide indications on early identification of patients for more or less postprocedural intensive management.
50
4
909
916
http://stroke.ahajournals.org/
contraindications; logistic models; nomograms; standard of care; thrombectomy; Aged; Aged, 80 and over; Brain Ischemia; Cerebral Hemorrhage; Female; Fibrinolytic Agents; Humans; Male; Middle Aged; Postoperative Complications; Risk Assessment; Risk Factors; Stroke; Thrombectomy; Thrombolytic Therapy; Tissue Plasminogen Activator; Nomograms
Cappellari M.; Mangiafico S.; Saia V.; Pracucci G.; Nappini S.; Nencini P.; Konda D.; Sallustio F.; Vallone S.; Zini A.; Bracco S.; Tassi R.; Bergui M.; Cerrato P.; Pitrone A.; Grillo F.; Saletti A.; De Vito A.; Gasparotti R.; Magoni M.; Puglielli E.; Casalena A.; Causin F.; Baracchini C.; Castellan L.; Malfatto L.; Menozzi R.; Scoditti U.; Comelli C.; Duc E.; Comai A.; Franchini E.; Cosottini M.; Mancuso M.; Peschillo S.; De Michele M.; Giorgianni A.; Delodovici M.L.; Lafe E.; Denaro M.F.; Burdi N.; Interno S.; Cavasin N.; Critelli A.; Chiumarulo L.; Petruzzellis M.; Doddi M.; Carolei A.; Auteri W.; Petrone A.; Padolecchia R.; Tassinari T.; Pavia M.; Invernizzi P.; Turcato G.; Forlivesi S.; Ciceri E.F.M.; Bonetti B.; Inzitari D.; Toni D.
File in questo prodotto:
File Dimensione Formato  
normogram.pdf

Accesso aperto

Descrizione: testo
Tipo di file: POSTPRINT (VERSIONE FINALE DELL’AUTORE)
Dimensione 445.08 kB
Formato Adobe PDF
445.08 kB Adobe PDF Visualizza/Apri
Stroke 2019.pdf

Accesso riservato

Tipo di file: PDF EDITORIALE
Dimensione 493.72 kB
Formato Adobe PDF
493.72 kB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/1731990
Citazioni
  • ???jsp.display-item.citation.pmc??? 17
  • Scopus 35
  • ???jsp.display-item.citation.isi??? 36
social impact