J Neurocrit Care.  2020 Jun;13(1):49-56. 10.18700/jnc.190104.

Predicting parenchymal hematoma associated with endovascular thrombectomy for acute occlusion of anterior circulation large vessel: the GuEss-MALiGn scale

  • 1Department of Neurology and Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea


Endovascular thrombectomy (EVT) is an emergency treatment for stroke caused by anterior circulation large vessel occlusion (ACLVO). This study aimed to identify the predictors for post-EVT parenchymal hematoma (PH) and to develop a predictive tool using the identified factors.
Using the clinical and imaging data of consecutive patients with acute ACLVO who underwent EVT, we performed a multivariate binary logistic regression analysis to identify predictors for PH. With the predictors proved by the regression, we developed a scale for predicting PH using receiver operating characteristic (ROC) curve analyses.
In 233 enrolled patients, the mean age was 72.3 years old, and the male proportion was 46.4%. The rate of PH after EVT was 18.0%: the rate of type 1 PH was 12.9%, and the rate of type 2 PH was 5.2%. The significant predictors for PH were basal ganglia involvement, embolism, male sex, antihyperlipidemic use, lobar infarction, and serum glucose level. We developed the GuEss-MALiGn scale with the six significant predictors. Each of these six items was placed on a Likert scale and scored as a 0 or 1. The ROC curve analysis revealed that the area under the curve was 0.771. The cutoff score for the risk of PH was >3. The sensitivity was 59.5%, and the specificity was 78.0%.
We propose the GuEss-MALiGn scale as a tool for predicting PH associated with EVT. Future external validation is needed to determine the reliability of this scale.


Cerebral infarction; Middle cerebral artery; Thrombectomy; Endovascular procedures; Postoperative complications; Cerebral hemorrhage
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