Predicting symptomatic intracranial hemorrhage after endovascular treatment of vertebrobasilar artery occlusion: PEACE score.
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Xu Yingjie, Alexandre Andrea Maria, Pedicelli Alessandro, Huang Xianjun, Wei Mingtong, Zhang Pan, Hu Miaomiao, Chen Xin, Guo Zhiliang, Zhu Juehua, Chen Hao, Ni Chuyuan, Fan Ligen, Wang Ruyue, Wang Qizhang, Wen Jianshang, Yang Yongliang, Chu Wuwei, Dai Zheng, Tan Shidong, Broccolini Aldobrando, Camilli Arianna, Abruzzese Serena, Cirelli Carlo, Bergui Mauro, Romi Dott Andrea, Scarcia Luca, Kalsoum Erwah, Frauenfelder Giulia, Meder Grzegorz, Scalise Simona, Ganimede Maria P, Bellini Luigi, Del Sette Bruno, Arba Francesco, Sammali Susanna, Salcuni Andrea, Vinci Sergio L, Cester Giacomo, Roveri Luisa, Wang Lei, Duan Zuowei, Zhang Shuai, Xu Guoqiang, Li Shizhan, Liang Yong, Wu Zongyi, Qin Shengfei, Luo Guanglin, Huang Zhixin, Xiao Lulu, Sun Wen
Аннотация
METHODS: 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.
RESULTS: 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)NCCT=0.85; AUCDWI=0.86), internal validation set (AUCNCCT=0.81; AUCDWI=0.82), and two additional external validation set (Asia: AUCNCCT=0.78, AUCDWI=0.80; Europe: AUCNCCT=0.74, AUCDWI=0.78).
CONCLUSION: The PEACE score reliably predicted the risk of sICH in VBAO patients who underwent EVT.