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

Manuel Cappellari, Salvatore Mangiafico, Valentina Saia, Giovanni Pracucci, Sergio Nappini, Patrizia Nencini, Daniel Konda, Fabrizio Sallustio, Stefano Vallone, Andrea Zini, Sandra Bracco, Rossana Tassi, Mauro Bergui, Paolo Cerrato, Antonio Pitrone, Francesco Grillo, Andrea Saletti, Alessandro De Vito, Roberto Gasparotti, Mauro MagoniEdoardo Puglielli, Alfonsina Casalena, Francesco Causin, Claudio Baracchini, Lucio Castellan, Laura Malfatto, Roberto Menozzi, Umberto Scoditti, Chiara Comelli, Enrica Duc, Alessio Comai, Enrica Franchini, Mirco Cosottini, Michelangelo Mancuso, Simone Peschillo, Manuela De Michele, Andrea Giorgianni, Maria Luisa Delodovici, Elvis Lafe, Maria Federica Denaro, Nicola Burdi, Saverio Internò, Nicola Cavasin, Adriana Critelli, Luigi Chiumarulo, Marco Petruzzellis, Marco Doddi, Antonio Carolei, William Auteri, Alfredo Petrone, Riccardo Padolecchia, Tiziana Tassinari, Marco Pavia, Paolo Invernizzi, Gianni Turcato, Stefano Forlivesi, Elisa Francesca Maria Ciceri, Bruno Bonetti, Domenico Inzitari, Danilo Toni, Listing of IER Collaborators

Research output: Contribution to journalArticle

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.
Original languageEnglish
Pages (from-to)909-916
Number of pages8
JournalStroke
Volume50
Issue number4
DOIs
Publication statusPublished - Apr 2019

Keywords

  • *contraindications
  • *logistic models
  • *nomograms
  • *standard of care
  • *thrombectomy
  • Aged
  • Aged, 80 and over
  • Brain Ischemia/complications/drug therapy/*surgery
  • Cerebral Hemorrhage/*etiology
  • Female
  • Fibrinolytic Agents/therapeutic use
  • Humans
  • Male
  • Middle Aged
  • *Nomograms
  • Postoperative Complications/etiology
  • Risk Assessment
  • Risk Factors
  • Stroke/complications/drug therapy/*surgery
  • Thrombectomy/*adverse effects
  • Thrombolytic Therapy/adverse effects
  • Tissue Plasminogen Activator/therapeutic use

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  • Cite this

    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., ... Collaborators, L. O. IER. (2019). IER-SICH Nomogram to Predict Symptomatic Intracerebral Hemorrhage After Thrombectomy for Stroke. Stroke, 50(4), 909-916. https://doi.org/10.1161/STROKEAHA.118.023316