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Symptomatic Intracranial Hemorrhage After Mechanical Thrombectomy in Chinese Ischemic Stroke Patients
Abstract
Background and Purpose:
Symptomatic intracranial hemorrhage (sICH), potentially associated with poor prognosis, is a major complication of endovascular thrombectomy (EVT) for ischemic stroke patients. We aimed to develop and validate a risk model for predicting sICH after EVT in Chinese patients due to large-artery occlusions in the anterior circulation.
Methods:
The derivation cohort recruited patients with EVT from the Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke Registry in China. sICH was diagnosed according to the Heidelberg Bleeding Classification within 24 hours of EVT. Stepwise logistic regression was performed to derive the predictive model. The discrimination and calibration of the risk model were assessed using the C index and the calibration plot. An additional cohort of 503 patients from 2 stroke centers was prospectively enrolled to validate the new model.
Results:
We enrolled 629 patients who underwent EVT as the derivation cohort, among whom 87 developed sICH (13.8%). In the multivariate adjustment, Alberta Stroke Program Early CT Score (odds ratio [OR], 0.85; P=0.005), baseline glucose (OR, 1.13; P=0.001), poor collateral circulation (OR, 3.06; P=0.001), passes with retriever (OR, 1.52; P=0.001), and onset-to-groin puncture time (OR, 1.79; P=0.024) were independent factors of sICH and were incorporated as the Alberta Stroke Program Early CT Score, Baseline Glucose, Poor Collateral Circulation, Passes With Retriever, and Onset-to-Groin Puncture Time (ASIAN) score. The ASIAN score demonstrated good discrimination in the derivation cohort (C index, 0.771 [95% CI, 0.716–0.826]), as well as the validation cohort (C index, 0.758 [95% CI, 0.691–0.825]).
Conclusions:
The ASIAN score reliably predicts the risk of sICH in Chinese ischemic stroke patients treated by EVT.
Introduction
Endovascular thrombectomy (EVT) is now accepted as a standard treatment for patients with ischemic stroke due to large-artery occlusions in anterior circulation.1 The most feared complication of EVT is symptomatic intracranial hemorrhage (sICH). Intracranial atherosclerosis may hamper the passage of the retriever devices to the targeted lesions and raise the possibility of blood vessel injury.2 Because more prevalent intracranial atherosclerosis is recognized in the Asian population, the intracranial hemorrhage risk after EVT maybe even elevated.3 The reported frequency of sICH is up to 16% in Asian patients.4 It potentially increases the risk of functional dependence4–7 and consequently decreases the benefit-risk ratio of EVT treatment. Hence, a reliable scoring tool identifying the probability of sICH is of vital importance for continuously improving the prognosis of EVT in the Asian race.
The Thrombolysis in Cerebral Ischaemia Score, Alberta Stroke Program Early CT Score, and Glucose Level (TAG) score8 and the sICH nomogram (National Institutes of Health Stroke Scale [NIHSS] score, onset-to-end procedure time, age, unsuccessful recanalization, and collateral circulation)9 have been established and validated in predicting sICH after EVT. However, those two predictive models for individualized prediction of sICH were unexceptionally derived from the European-American ancestry. The discrepant causes of artery occlusion among ethnical groups emphasize the need to develop a predictive model based on the different populations. We, therefore, aimed to develop and validate a risk model with enough power for predicting sICH in Chinese ischemic stroke patients treated with EVT.
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