Zhang Jian, Liu Juan, Chen Shijian, Li Huagang, Luo Jun, Wu Youlin, Zhou Peiyang, Huang Wenguo, Wan Yue, Qiu Tao, Meng Renliang, Zi Wenjie, Shi Shengliang, Kong Deyan, Zhang Yueling, Peng Yuqi, Liu Shudong, Liang Zhijian
Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
Clin Neurol Neurosurg. 2022 Apr;215:107184. doi: 10.1016/j.clineuro.2022.107184. Epub 2022 Feb 25.
This study aimed to develop a score to predict the risk for symptomatic intracranial haemorrhage (sICH) associated with endovascular treatment (EVT) in patients with acute ischaemic stroke caused by large vessel occlusions (LVOs) in the anterior circulation.
Between January 2017 and December 2019, acute stroke patients with anterior circulation occlusion and EVT were retrospectively enroled from 11 comprehensive stroke centres in China. Univariate analyses were performed to compare the factors in patients with or without sICH. The predictive value of parameters associated with sICH was evaluated with multivariate logistic regression, and the score was developed according to the magnitude of regression coefficients. We performed external validation in a retrospective stroke registry of EVT for acute anterior circulation ischaemic stroke in 21 comprehensive stroke centres across 10 provinces in China (ACTUAL).
Of the 433 patients, 70 (16.2%) patients had sICH. The preoperative predictive factors of sICH were poor collateral circulation, low baseline ASPECTS, cardioembolic stroke and high serum glucose. Using the OR of preoperative predictive factors (collateral circulation status, baseline ASPECTS, TOAST type and serum glucose) in the multivariable model, we derived the ACTS score. In the derivation cohort, the area under the ROC curve (AUC) was 0.797; in the validation cohort, it was 0.727.
The ACTS score provides a quick and easy-to-perform scale to predict the risk of sICH in acute anterior circulation stroke patients treated with EVT. This score should be further examined and improved in future prospective studies to increase its precision and applicability before it can be recommended to make clinical decisions regarding the performance of EVT.
本研究旨在制定一个评分系统，以预测前循环大血管闭塞（LVO）所致急性缺血性卒中患者血管内治疗（EVT）相关症状性颅内出血（sICH）的风险。
2017年1月至2019年12月，从中国11个综合卒中中心回顾性纳入前循环闭塞并接受EVT的急性卒中患者。进行单因素分析以比较有或无sICH患者的因素。采用多因素逻辑回归评估与sICH相关参数的预测价值，并根据回归系数大小制定评分系统。我们在中国10个省份的21个综合卒中中心对急性前循环缺血性卒中EVT的回顾性卒中登记处（ACTUAL）进行了外部验证。
433例患者中，70例（16.2%）发生sICH。sICH的术前预测因素为侧支循环差、基线ASPECTS评分低、心源性卒中及血糖高。利用多变量模型中术前预测因素（侧支循环状态、基线ASPECTS评分、TOAST分型和血糖）的OR值，我们得出了ACTS评分。在推导队列中，ROC曲线下面积（AUC）为0.797；在验证队列中，为0.727。
ACTS评分提供了一种快速且易于操作的量表，用于预测接受EVT治疗的急性前循环卒中患者发生sICH的风险。在推荐该评分用于指导EVT临床决策之前，应在未来的前瞻性研究中进一步检验和改进，以提高其准确性和适用性。
