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 Magoni; Edoardo 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

doi:10.1161/STROKEAHA.118.023316

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 journal › Article › peer-review

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 language	English
Pages (from-to)	909-916
Number of pages	8
Journal	Stroke
Volume	50
Issue number	4
DOIs	https://doi.org/10.1161/STROKEAHA.118.023316
Publication status	Published - 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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10.1161/STROKEAHA.118.023316

https://pubmed.ncbi.nlm.nih.gov/31233386

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

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, ML, Lafe, E , Denaro, MF, Burdi, N, Internò, 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, EFM, Bonetti, B, Inzitari, D, Toni, D & Collaborators, LOIER 2019, 'IER-SICH Nomogram to Predict Symptomatic Intracerebral Hemorrhage After Thrombectomy for Stroke', Stroke, vol. 50, no. 4, pp. 909-916. https://doi.org/10.1161/STROKEAHA.118.023316

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title = "IER-SICH Nomogram to Predict Symptomatic Intracerebral Hemorrhage After Thrombectomy for Stroke",

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.",

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",

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

year = "2019",

month = apr,

doi = "10.1161/STROKEAHA.118.023316",

language = "English",

volume = "50",

pages = "909--916",

journal = "Stroke",

issn = "0039-2499",

publisher = "Lippincott Williams and Wilkins",

number = "4",

}

TY - JOUR

T1 - IER-SICH Nomogram to Predict Symptomatic Intracerebral Hemorrhage After Thrombectomy for Stroke

AU - Cappellari, Manuel

AU - Mangiafico, Salvatore

AU - Saia, Valentina

AU - Pracucci, Giovanni

AU - Nappini, Sergio

AU - Nencini, Patrizia

AU - Konda, Daniel

AU - Sallustio, Fabrizio

AU - Vallone, Stefano

AU - Zini, Andrea

AU - Bracco, Sandra

AU - Tassi, Rossana

AU - Bergui, Mauro

AU - Cerrato, Paolo

AU - Pitrone, Antonio

AU - Grillo, Francesco

AU - Saletti, Andrea

AU - De Vito, Alessandro

AU - Gasparotti, Roberto

AU - Magoni, Mauro

AU - Puglielli, Edoardo

AU - Casalena, Alfonsina

AU - Causin, Francesco

AU - Baracchini, Claudio

AU - Castellan, Lucio

AU - Malfatto, Laura

AU - Menozzi, Roberto

AU - Scoditti, Umberto

AU - Comelli, Chiara

AU - Duc, Enrica

AU - Comai, Alessio

AU - Franchini, Enrica

AU - Cosottini, Mirco

AU - Mancuso, Michelangelo

AU - Peschillo, Simone

AU - De Michele, Manuela

AU - Giorgianni, Andrea

AU - Delodovici, Maria Luisa

AU - Lafe, Elvis

AU - Denaro, Maria Federica

AU - Burdi, Nicola

AU - Internò, Saverio

AU - Cavasin, Nicola

AU - Critelli, Adriana

AU - Chiumarulo, Luigi

AU - Petruzzellis, Marco

AU - Doddi, Marco

AU - Carolei, Antonio

AU - Auteri, William

AU - Petrone, Alfredo

AU - Padolecchia, Riccardo

AU - Tassinari, Tiziana

AU - Pavia, Marco

AU - Invernizzi, Paolo

AU - Turcato, Gianni

AU - Forlivesi, Stefano

AU - Ciceri, Elisa Francesca Maria

AU - Bonetti, Bruno

AU - Inzitari, Domenico

AU - Toni, Danilo

AU - Collaborators, Listing of IER

PY - 2019/4

Y1 - 2019/4

N2 - 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.

AB - 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.

KW - contraindications

KW - logistic models

KW - nomograms

KW - standard of care

KW - thrombectomy

KW - Aged

KW - Aged, 80 and over

KW - Brain Ischemia/complications/drug therapy/surgery

KW - Cerebral Hemorrhage/etiology

KW - Female

KW - Fibrinolytic Agents/therapeutic use

KW - Humans

KW - Male

KW - Middle Aged

KW - Nomograms

KW - Postoperative Complications/etiology

KW - Risk Assessment

KW - Risk Factors

KW - Stroke/complications/drug therapy/surgery

KW - Thrombectomy/adverse effects

KW - Thrombolytic Therapy/adverse effects

KW - Tissue Plasminogen Activator/therapeutic use

U2 - 10.1161/STROKEAHA.118.023316

DO - 10.1161/STROKEAHA.118.023316

M3 - Article

VL - 50

SP - 909

EP - 916

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 4

ER -

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

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Keywords

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