A New Score Predicts Intracranial Hemorrhage After Mechanical Thrombectomy

The following article is part of coverage from the American Academy of Neurology’s Annual Meeting (AAN 2020). Due to the global COVID-19 pandemic, the Academy made the necessary decision to cancel the meeting originally scheduled for April 25–May 1, 2020, in Toronto. While live events will not proceed as planned, readers can click here catch up on the latest research intended to be presented at the meeting.

In patients after mechanical thrombectomy, high result from the novel TAG score are associated with increased risk for symptomatic intracranial hemorrhage (ICH), according to study results intended to be presented at the annual meeting of the American Academy of Neurology (AAN 2020).

Because there are limited data on predictors of symptomatic ICH in patients following mechanical thrombectomy, the goal of the study was to identify such predictors.

Data on patients treated with mechanical thrombectomy at a comprehensive stroke center were collected and the researchers compared characteristics between those with and without symptomatic ICH to identify potential predictors. Independent predictors were combined to derive a symptomatic ICH prediction score that was then externally validated using data from the Blood Pressure After Endovascular Treatment (BEST) multicenter prospective registry.

Of 578 patients who received thrombectomy for acute ischemic stroke, 19 had symptomatic ICH (3.3%). Several significant factors were found to be independent predictors of symptomatic ICH, including the Thrombolysis in Cerebral Ischemic (TICI) score (odds ratio [OR], 5.00 per unit decrease; 95% CI, 1.85-14.29; P =.002), the Alberta Stroke Program Early Computed Tomography Score (ASPECTS; OR, 1.52 per 1 point decrease; 95% CI, 1.01-1.13; P =.018) and glucose level (OR per 10 mg/dL increase, 1.07 per mg/dL increase; 95% CI: 1.01-1.13; P =.018).

Using a multivariate logistic regression model, the researchers derived the weighted TAG score which was found to be statistically significant associated with symptomatic ICH in the derivation cohort (OR, 1.98 per 1 unit increase; 95% CI, 1.48 to 2.66, P <.001) and in the validation cohort (OR, 1.48 per 1 unit increase; 95% CI, 1.22 to 1.79, P <.001).

“High TAG scores are associated with [symptomatic] ICH in patients receiving mechanical thrombectomy. Larger studies are needed to validate this scoring system and test interventions and strategies to reduce symptomatic ICH risk and make thrombectomy safer in patients with elevated TAG scores”, concluded the researchers.

Reference

Montalvo M, Mistry E, Chang AD, et al. Predicting symptomatic intracranial haemorrhage after mechanical thrombectomy: the TAG score. Intended to be presented at the 2020 annual meeting of the American Academy of Neurology.

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