Predicting symptomatic intracranial hemorrhage after endovascular treatment of vertebrobasilar artery occlusion: PEACE score.
Authors
Affiliations (50)
Affiliations (50)
- Department of Neurology, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
- UOC Radiologia e Neuroradiologia, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
- UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui, China.
- Department of Hepatic Surgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China.
- Department of Neurology, Bengbu Medical College, Bengbu, Anhui, China.
- Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China.
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
- Department of Neurology, The First Affliated Hospital of Soochow University, Suzhou, Jiangsu, China.
- Department of Neurology, First Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
- Department of Neurology, Huangshan City People's Hospital, Huangshan, Anhui, China.
- Department of Neurology, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China.
- Department of Neurology, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, Guangdong, China.
- Department of Neurology, Shucheng County People's Hospital, Luan, Anhui, China.
- Department of Neurology, Suixi County Hospital of Traditional Chinese Medicine, Huaibei, Anhui, China.
- Department of Neurology, Tongcheng City People's Hospital, Tongcheng, Anhui, China.
- Department of Neurology, Wuxi People's Hospital, Wuxi, Jiangsu, China.
- Department of Neurology, Second Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China.
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.
- Catholic University of Sacred Heart, Rome, Italy.
- Catholic University School of Medicine, Rome, Italy.
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy.
- Interventional Neuroradiology, Università degli Studi di Torino, Torino, Italy.
- IRCCS Policlinico San Matteo, Pavia, Italy.
- Diagnostic and Interventional Neuroradiology, Hospital Foch, Créteil, France.
- Neuroradiology Unit, Hospital Henri Mondor, Creteil, France.
- Neuroradiology, Neuroradiology Unit, AOU S Giovanni di Dio e Ruggi di Aragona, Salerno, Italy.
- Department of Interventional Radiology, Jan Biziel University Hospital No 2 in Bydgoszcz, Bydgoszcz, Poland.
- Neurology, Hospital Vito Fazzi, Lecce, Italy.
- Interventional Radiology, Interventional Radiology Unit, 'SS Annunziata' Hospital, Taranto, Italy.
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy.
- IRCCS Ospedale Policlinico San Martino, Genova, Italy.
- Emergency Department, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy.
- Azienda Ospedaliera Universitaria Policlinico G Martino, Messina, Italy.
- Radiological Sciences, Oncology, and Pathology, University of Rome La Sapienza, Rome, Italy.
- Neuroradiology Unit, Department of Radiological Sciences, University of Messina, Messina, Italy.
- Neuroradiology Unit, Policlinico Universitario di Padova, Padua, Italy.
- Neurology Unit, IRCCS San Raffaele University Hospital, Milan, Italy.
- Department of Neurology, Xuzhou Central Hospital, Xuzhou, Jiangsu, China.
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
- Department of Neurology, The Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, China.
- Department of Neurology, First People's Hospital of Yongkang, Yongkang, Zhejiang, China.
- Department of Neurology, First People's Hospital of Yulin, Yulin, Guangxi, China.
- Department of Neurology, First Hospital of Changsha, Changsha, Hunan, China.
- Department of Neurology, Hospital of Traditional Chinese Medicine of Zhongshan, Zhongshan, Guangdong, China.
- Department of Neurology, Zhong Mei Kuang Jian Zong Yi Yuan, Suzhou, Anhui, China.
- Department of Neurology, Funan County People's Hospital, Fuyang, Anhui, China.
- Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China.
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China [email protected] [email protected].
- Department of Neurology, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China [email protected] [email protected].
Abstract
Current clinical decision tools for assessing the risk of symptomatic intracranial hemorrhage (sICH) in patients with vertebrobasilar artery occlusion (VBAO) who received endovascular treatment (EVT) have limited performance. This study develops and validates a clinical risk score to precisely estimate the risk of sICH in VBAO patients. The derivation cohort recruited patients with VBAO who received EVT from the Posterior Circulation IschemIc Stroke Registry in China. Based on the posterior circulation-Alberta Stroke Program Early CT Score (pc-ASPECTS) evaluation method, the cohort was further divided into non-contrast CT (NCCT) and diffusion weighted imaging (DWI) cohorts to construct predictive models. sICH was diagnosed according to the Heidelberg Bleeding Classification within 48 hours of EVT. Clinical signature was constructed in the derivation cohort using machine learning and was validated in two additional cohorts from Asia and Europe. We enrolled 1843 patients who underwent EVT and had complete data. pc-ASPECTS of 1710 patients was evaluated on NCCT and 699 patients on DWI. In the NCCT cohort, 1364 individuals made up the training set, of whom 101 (7.4%) developed sICH. In the DWI cohort, the training set consisted of 560 individuals, with 44 (7.9%) experiencing sICH. Predictors of sICH were: glucose, pc-ASPECTS, time from estimated occlusion to groin puncture (EOT), poor collateral circulation, and modified Thrombolysis in Cerebral Infarction (mTICI) score. From these predictors, we derived the weighted poor collateral circulation-EOT-pc-ASPECTS-mTICI-glucose (PEACE) score. The PEACE score showed good discrimination in the training set (area under the curve (AUC)<sub>NCCT</sub>=0.85; AUC<sub>DWI</sub>=0.86), internal validation set (AUC<sub>NCCT</sub>=0.81; AUC<sub>DWI</sub>=0.82), and two additional external validation set (Asia: AUC<sub>NCCT</sub>=0.78, AUC<sub>DWI</sub>=0.80; Europe: AUC<sub>NCCT</sub>=0.74, AUC<sub>DWI</sub>=0.78). The PEACE score reliably predicted the risk of sICH in VBAO patients who underwent EVT.