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IER-SICH Nomogram to Predict Symptomatic Intracerebral Hemorrhage After Thrombectomy for Stroke.
Stroke 2019; 50(4):909-916S

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.

Authors+Show Affiliations

Stroke Unit (M. Cappellari, S.F., B.B.), Azienda Ospedaliera Universitaria Integrata, Verona, Italy.Interventional Neuroradiology Unit (S.M., S.N.), Ospedale Careggi-University Hospital, Firenze, Italy.Neurology and Stroke Unit (T.T., V.S.), Santa Corona Hospital, Pietra Ligure, Italy.Stroke Unit (D.I., P.N., G.P.), Ospedale Careggi-University Hospital, Firenze, Italy. University of Florence, Firenze, Italy (G.P., P.N., D.I.).Interventional Neuroradiology Unit (S.M., S.N.), Ospedale Careggi-University Hospital, Firenze, Italy.Stroke Unit (D.I., P.N., G.P.), Ospedale Careggi-University Hospital, Firenze, Italy. University of Florence, Firenze, Italy (G.P., P.N., D.I.).Interventional Neuroradiology Unit (D.K.), Policlinico Tor Vergata, Roma, Italy.Stroke Unit (F.S.), Policlinico Tor Vergata, Roma, Italy.Neuroradiology Unit, Ospedale Civile S. Agostino-Estense University Hospital, Modena, Italy (S.V.).Stroke Unit, IRCCS Istituto delle Scienze Neurologiche, Maggiore Hospital, Bologna, Italy (A.Z.).Interventional Neuroradiology Unit (S.B.), Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy.Stroke Unit (R.T.), Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy.Interventional Neuroradiology Unit (M.B.), Città della Salute e della Scienza-Molinette, Torino, Italy.Stroke Unit (P.C.), Città della Salute e della Scienza-Molinette, Torino, Italy.Interventional Neuroradiology Unit (A. Pitrone), Policlinico G. Martino, Messina, Italy.Stroke Unit (F.G.), Policlinico G. Martino, Messina, Italy.Interventional Neuroradiology Unit (A.S.), Arcispedale S. Anna-University Hospital, Ferrara, Italy.Stroke Unit (A.D.V.), Arcispedale S. Anna-University Hospital, Ferrara, Italy.Neuroradiology Unit (R.G.), Spedali Civili, Brescia, Italy.Stroke Unit (M. Magoni), Spedali Civili, Brescia, Italy.Vascular and Interventional Radiology Unit (E.P.), Ospedale Civile Mazzini, Teramo, Italy.Neurology Unit (A. Casalena), Ospedale Civile Mazzini, Teramo, Italy.Neuroradiology Unit (F.C.), Azienda Ospedaliero-Univeristaria, Padova, Italy.Stroke Unit (C.B.), Azienda Ospedaliero-Univeristaria, Padova, Italy.Interventional Neuroradiology Unit (L. Castellan), IRCCS San Martino-IST, Genova, Italy.Stroke Unit (L.M.), IRCCS San Martino-IST, Genova, Italy.Interventional Neuroradiology Unit (R.M.), Ospedale Universitario, Parma, Italy.Stroke Unit (U.S.), Ospedale Universitario, Parma, Italy.Interventional Neuroradiology Unit (C.C.), Ospedale San Giovanni Bosco, Torino, Italy.Neurology Unit (E.D.), Ospedale San Giovanni Bosco, Torino, Italy.Radiology Unit (A. Comai), Ospedale Centrale, Bolzano, Italy.Stroke Unit (E.F.), Ospedale Centrale, Bolzano, Italy.Neuroradiology Unit (M. Cosottini), Ospedale Cisanello, Pisa, Italy.Neurology Unit (M. Mancuso), Ospedale Cisanello, Pisa, Italy.Interventional Neuroradiology Unit (S.P.), Sapienza University Hospital, Roma, Italy.Stroke Unit (M.D.M., D.T.), Sapienza University Hospital, Roma, Italy.Neuroradiology Unit (A.G.), Ospedale Universitario Circolo, ASST Sette Laghi, Varese, Italy.Stroke Unit (M.L.D.), Ospedale Universitario Circolo, ASST Sette Laghi, Varese, Italy.Diagnostic and Interventional Neuroradiology Unit (E.L.), San Matteo Hospital and C. Mondino Foundation, Pavia, Italy.Stroke Unit (M.F.D.), San Matteo Hospital and C. Mondino Foundation, Pavia, Italy.Interventional Radiology Unit (N.B.), Ospedale SS. Annunziata, Taranto, Italy.Stroke Unit (S.I.), Ospedale SS. Annunziata, Taranto, Italy.Neuroradiology Unit (N.C.), Ospedale dell'Angelo, USSL3 Serenissima, Mestre, Italy.Neurology Unit (A. Critelli), Ospedale dell'Angelo, USSL3 Serenissima, Mestre, Italy.Stroke Unit (L. Chiumarulo), Policlinico, Bari, Italy.Interventional Neuroradiology Unit (M. Petruzzellis), Policlinico, Bari, Italy.Interventional Neuroradiology Unit (M.D.), Presidio Ospedaliero SS. Filippo e Nicola, Avezzano, Italy.Stroke Unit (A. Carolei), Presidio Ospedaliero SS. Filippo e Nicola, Avezzano, Italy.Interventional Neuroradiology Unit (W.A.), Azienda Ospedaliera Annunziata, Cosenza, Italy.Neurology Unit (A. Petrone), Azienda Ospedaliera Annunziata, Cosenza, Italy.Neuroradiology Unit (R.P.), Santa Corona Hospital, Pietra Ligure, Italy.Neurology and Stroke Unit (T.T., V.S.), Santa Corona Hospital, Pietra Ligure, Italy.Interventional Neuroradiology Unit (M. Pavia), Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy.Stroke Unit (P.I.), Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy.Emergency Department, Girolamo Fracastoro Hospital, San Bonifacio (Verona), Italy (G.T.).Stroke Unit (M. Cappellari, S.F., B.B.), Azienda Ospedaliera Universitaria Integrata, Verona, Italy.From the Neuroradiology Unit (E.F.M.C.), Azienda Ospedaliera Universitaria Integrata, Verona, Italy.Stroke Unit (M. Cappellari, S.F., B.B.), Azienda Ospedaliera Universitaria Integrata, Verona, Italy.Stroke Unit (D.I., P.N., G.P.), Ospedale Careggi-University Hospital, Firenze, Italy. University of Florence, Firenze, Italy (G.P., P.N., D.I.).Stroke Unit (M.D.M., D.T.), Sapienza University Hospital, Roma, Italy.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31233386

Citation

Cappellari, Manuel, et al. "IER-SICH Nomogram to Predict Symptomatic Intracerebral Hemorrhage After Thrombectomy for Stroke." Stroke, vol. 50, no. 4, 2019, pp. 909-916.
Cappellari M, Mangiafico S, Saia V, et al. IER-SICH Nomogram to Predict Symptomatic Intracerebral Hemorrhage After Thrombectomy for Stroke. Stroke. 2019;50(4):909-916.
Cappellari, M., Mangiafico, S., Saia, V., Pracucci, G., Nappini, S., Nencini, P., ... Toni, D. (2019). IER-SICH Nomogram to Predict Symptomatic Intracerebral Hemorrhage After Thrombectomy for Stroke. Stroke, 50(4), pp. 909-916. doi:10.1161/STROKEAHA.118.023316.
Cappellari M, et al. IER-SICH Nomogram to Predict Symptomatic Intracerebral Hemorrhage After Thrombectomy for Stroke. Stroke. 2019;50(4):909-916. PubMed PMID: 31233386.
* Article titles in AMA citation format should be in sentence-case
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 - ,, Y1 - 2019/03/14/ PY - 2019/6/25/entrez PY - 2019/6/25/pubmed PY - 2019/6/25/medline KW - contraindications KW - logistic models KW - nomograms KW - standard of care KW - thrombectomy SP - 909 EP - 916 JF - Stroke JO - Stroke VL - 50 IS - 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. SN - 1524-4628 UR - https://www.unboundmedicine.com/medline/citation/31233386/IER-SICH_Nomogram_to_Predict_Symptomatic_Intracerebral_Hemorrhage_After_Thrombectomy_for_Stroke L2 - http://www.ahajournals.org/doi/full/10.1161/STROKEAHA.118.023316?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -