J Stroke.  2025 Jan;27(1):85-94. 10.5853/jos.2024.04119.

Predictive Modeling of Symptomatic Intracranial Hemorrhage Following Endovascular Thrombectomy: Insights From the Nationwide TREAT-AIS Registry

• Chen JH
• Su IC
• Lu YH
• Hsieh YC
• Chen CH
• Lin CJ
• Chen YW
• Lin KH
• Sung PS
• Tang CW
• Chu HJ
• Fu CH
• Chou CL
• Wei CY
• Yan SY
• Chen PL
• Yeh HL
• Sung SF
• Liu HM
• Lin CH
• Lee M
• Tang SC
• Lee IH
• Chan L
• Lien LM
• Chiou HY
• Lee JT
• Jeng JS
• on Behalf of the Nationwide TREAT-AIS Investigators

• KMID: 2564265
• DOI: http://doi.org/10.5853/jos.2024.04119

Abstract

Background and Purpose
Symptomatic intracranial hemorrhage (sICH) following endovascular thrombectomy (EVT) is a severe complication associated with adverse functional outcomes and increased mortality rates. Currently, a reliable predictive model for sICH risk after EVT is lacking.
Methods
This study used data from patients aged ≥20 years who underwent EVT for anterior circulation stroke from the nationwide Taiwan Registry of Endovascular Thrombectomy for Acute Ischemic Stroke (TREAT-AIS). A predictive model including factors associated with an increased risk of sICH after EVT was developed to differentiate between patients with and without sICH. This model was compared existing predictive models using nationwide registry data to evaluate its relative performance.
Results
Of the 2,507 identified patients, 158 developed sICH after EVT. Factors such as diastolic blood pressure, Alberta Stroke Program Early CT Score, platelet count, glucose level, collateral score, and successful reperfusion were associated with the risk of sICH after EVT. The TREAT-AIS score demonstrated acceptable predictive accuracy (area under the curve [AUC]=0.694), with higher scores being associated with an increased risk of sICH (odds ratio=2.01 per score increase, 95% confidence interval=1.64–2.45, P<0.001). The discriminatory capacity of the score was similar in patients with symptom onset beyond 6 hours (AUC=0.705). Compared to existing models, the TREAT-AIS score consistently exhibited superior predictive accuracy, although this difference was marginal.
Conclusions
The TREAT-AIS score outperformed existing models, and demonstrated an acceptable discriminatory capacity for distinguishing patients according to sICH risk levels. However, the differences between models were only marginal. Further research incorporating periprocedural and postprocedural factors is required to improve the predictive accuracy.

Keyword

Symptomatic intracranial hemorrhage; Endovascular thrombectomy; Prediction

Figure

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  Figure 1. Receiver operating characteristic (ROC) curve for the prediction of symptomatic intracranial hemorrhage after endovascular thrombectomy. The ROC curve showed that the TREAT-AIS score had a higher predictive accuracy than the TAG, ASIAN, IER-SICH nomogram, and STBA scores. TREAT-AIS, Taiwan Registry of Endovascular Thrombectomy for Acute Ischemic Stroke; AUC, area under the curve. TREAT-AIS, Taiwan Registry of Endovascular Thrombectomy for Acute Ischemic Stroke; TAG, TICI-ASPECTSglucose; ASIAN, ASPECTS, baseline glucose, poor collateral circulation, passes with retriever, and onset-to-groin puncture time; IER-SICH, Italian Registry of Endovascular Stroke Treatment in Acute Stroke–symptomatic intracerebral hemorrhage; STBA, systolic blood pressure, time from acute ischemic stroke until groin puncture, blood glucose, and ASPECTS.

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  Figure 2. Receiver operating characteristic curve for the prediction of symptomatic intracranial hemorrhage after endovascular thrombectomy in patients with symptom onset beyond 6 hours. In patients who underwent endovascular thrombectomy with symptom onset beyond 6 hours, most scores demonstrated improved predictive accuracy, except for the IER-SICH nomogram. AUC, area under the curve; TREAT-AIS, Taiwan Registry of Endovascular Thrombectomy for Acute Ischemic Stroke; TAG, TICI-ASPECTSglucose; ASIAN, ASPECTS, baseline glucose, poor collateral circulation, passes with retriever, and onset-to-groin puncture time; IER-SICH, Italian Registry of Endovascular Stroke Treatment in Acute Stroke–symptomatic intracerebral hemorrhage; STBA, systolic blood pressure, time from acute ischemic stroke until groin puncture, blood glucose, and ASPECTS.

Reference

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