Yingjie Xu, Andrea Maria Alexandre, Alessandro Pedicelli, Xianjun Huang, Mingtong Wei, Pan Zhang, Miaomiao Hu, Xin Chen, Zhiliang Guo, Juehua Zhu, Hao Chen, Chuyuan Ni, Ligen Fan, Ruyue Wang, Qizhang Wang, Jianshang Wen, Yongliang Yang, Wuwei Chu, Zheng Dai, Shidong Tan, Aldobrando Broccolini, Arianna Camilli, Serena Abruzzese, Carlo Cirelli, Mauro Bergui, Dott Andrea Romi, Luca Scarcia, Erwah Kalsoum, Giulia Frauenfelder, Grzegorz Meder, Simona Scalise, Maria P Ganimede, Luigi Bellini, Bruno Del Sette, Francesco Arba, Susanna Sammali, Andrea Salcuni, Sergio L Vinci, Giacomo Cester, Luisa Roveri, Lei Wang, Zuowei Duan, Shuai Zhang, Guoqiang Xu, Shizhan Li, Yong Liang, Zongyi Wu, Shengfei Qin, Guanglin Luo, Zhixin Huang, Lulu Xiao, Wen Sun
{"title":"Predicting symptomatic intracranial hemorrhage after endovascular treatment of vertebrobasilar artery occlusion: PEACE score.","authors":"Yingjie Xu, Andrea Maria Alexandre, Alessandro Pedicelli, Xianjun Huang, Mingtong Wei, Pan Zhang, Miaomiao Hu, Xin Chen, Zhiliang Guo, Juehua Zhu, Hao Chen, Chuyuan Ni, Ligen Fan, Ruyue Wang, Qizhang Wang, Jianshang Wen, Yongliang Yang, Wuwei Chu, Zheng Dai, Shidong Tan, Aldobrando Broccolini, Arianna Camilli, Serena Abruzzese, Carlo Cirelli, Mauro Bergui, Dott Andrea Romi, Luca Scarcia, Erwah Kalsoum, Giulia Frauenfelder, Grzegorz Meder, Simona Scalise, Maria P Ganimede, Luigi Bellini, Bruno Del Sette, Francesco Arba, Susanna Sammali, Andrea Salcuni, Sergio L Vinci, Giacomo Cester, Luisa Roveri, Lei Wang, Zuowei Duan, Shuai Zhang, Guoqiang Xu, Shizhan Li, Yong Liang, Zongyi Wu, Shengfei Qin, Guanglin Luo, Zhixin Huang, Lulu Xiao, Wen Sun","doi":"10.1136/jnis-2024-022802","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>The PEACE score reliably predicted the risk of sICH in VBAO patients who underwent EVT.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5000,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of NeuroInterventional Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/jnis-2024-022802","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NEUROIMAGING","Score":null,"Total":0}
引用次数: 0
Abstract
Background: 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.
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.
期刊介绍：
The Journal of NeuroInterventional Surgery (JNIS) is a leading peer review journal for scientific research and literature pertaining to the field of neurointerventional surgery. The journal launch follows growing professional interest in neurointerventional techniques for the treatment of a range of neurological and vascular problems including stroke, aneurysms, brain tumors, and spinal compression.The journal is owned by SNIS and is also the official journal of the Interventional Chapter of the Australian and New Zealand Society of Neuroradiology (ANZSNR), the Canadian Interventional Neuro Group, the Hong Kong Neurological Society (HKNS) and the Neuroradiological Society of Taiwan.
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