Cerebrovascular diseases (Basel, Switzerland) · 2026
The AMORE Score for Predicting the 5-Year Risk of Hemorrhagic Stroke in Asymptomatic Moyamoya Disease.
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Hishikawa Tomohito, Murai Satoshi, Ito Yoichi M, Funaki Takeshi, Fujimura Miki, Hamano Eika, Kataoka Hiroharu, Takahashi Jun C, Endo Hidenori, Inaji Motoki, Nariai Tadashi, Honjo Kaori, Osato Toshiaki, Miyawaki Satoru, Saito Nobuhito, Isozaki Makoto, Kikuta Kenichiro, Machida Toshio, Mase Mitsuhito, Yamaguchi Koji, Kawamata Takakazu, Sato Norihiro, Yamamoto Shusuke, Hori Emiko, Kashiwazaki Daina, Miyamoto Susumu, Kuroda Satoshi
Аннотация
INTRODUCTION: The aim of this study was to establish the score for predicting the 5-year risk of hemorrhagic stroke in patients with asymptomatic moyamoya disease (MMD) using the Asymptomatic Moyamoya Registry (AMORE) data and to evaluate its reproducibility.
METHODS: The AMORE study was a prospective cohort study that recruited participants from 18 centers in Japan. A total of 103 patients completed the 5-year follow-up and of these, 6 patients experienced hemorrhagic stroke. According to the results of multivariate analysis, we selected age ≥46 years, grade-2 choroidal anastomosis, and microbleeds as variables in the prediction model. The cumulative rates of hemorrhagic stroke were estimated per hemisphere using the Kaplan-Meier method. Nonparametric bias-corrected confidence intervals (CIs) based on the Bootstrap sample were calculated to assess the reproducibility of the 5-year risk of hemorrhagic stroke.
RESULTS: We created the AMORE score (0-3 points) to estimate the 5-year risk of hemorrhage with 1 point for each of age ≥46 years, grade-2 choroidal anastomosis, and microbleeds. The AMORE score was applied to a total of 135 MMD hemispheres. The 5-year risk of hemorrhagic stroke per hemisphere was 1.8%, 1.6%, 15.4%, and 50.0% for AMORE scores of 0, 1, 2, and 3, respectively. The cumulative rate of hemorrhagic stroke for AMORE score 3 was significantly higher than for AMORE score 0 (hazard ratio [HR], 38.7; 95% CI, 3.45-433; p = 0.003) and score 1 (HR, 41.8; 95% CI, 3.74-468; p = 0.002). The corresponding 90% CIs were 0%-5.6%, 0%-5.2%, 0%-38.5%, and 0%-100%, and the corresponding 80% CIs were 0%-4.7%, 0%-4.5%, 5.9%-33.3%, and 23%-100% for AMORE scores 0, 1, 2, and 3, respectively.
CONCLUSION: The 5-year risk of hemorrhagic stroke in patients with asymptomatic MMD can be adequately estimated using the AMORE score.
METHODS: The AMORE study was a prospective cohort study that recruited participants from 18 centers in Japan. A total of 103 patients completed the 5-year follow-up and of these, 6 patients experienced hemorrhagic stroke. According to the results of multivariate analysis, we selected age ≥46 years, grade-2 choroidal anastomosis, and microbleeds as variables in the prediction model. The cumulative rates of hemorrhagic stroke were estimated per hemisphere using the Kaplan-Meier method. Nonparametric bias-corrected confidence intervals (CIs) based on the Bootstrap sample were calculated to assess the reproducibility of the 5-year risk of hemorrhagic stroke.
RESULTS: We created the AMORE score (0-3 points) to estimate the 5-year risk of hemorrhage with 1 point for each of age ≥46 years, grade-2 choroidal anastomosis, and microbleeds. The AMORE score was applied to a total of 135 MMD hemispheres. The 5-year risk of hemorrhagic stroke per hemisphere was 1.8%, 1.6%, 15.4%, and 50.0% for AMORE scores of 0, 1, 2, and 3, respectively. The cumulative rate of hemorrhagic stroke for AMORE score 3 was significantly higher than for AMORE score 0 (hazard ratio [HR], 38.7; 95% CI, 3.45-433; p = 0.003) and score 1 (HR, 41.8; 95% CI, 3.74-468; p = 0.002). The corresponding 90% CIs were 0%-5.6%, 0%-5.2%, 0%-38.5%, and 0%-100%, and the corresponding 80% CIs were 0%-4.7%, 0%-4.5%, 5.9%-33.3%, and 23%-100% for AMORE scores 0, 1, 2, and 3, respectively.
CONCLUSION: The 5-year risk of hemorrhagic stroke in patients with asymptomatic MMD can be adequately estimated using the AMORE score.