IER-SICH Nomogram to Predict Symptomatic Intracerebral Hemorrhage After Thrombectomy for Stroke
Authors: Cappellari Manuel , Mangiafico Salvatore , Saia Valentina , Pracucci Giovanni , Nappini Sergio , Nencini Patrizia , Konda Daniel , Sallustio Fabrizio , Vallone Stefano , Zini Andrea , Bracco Sandra , Tassi Rossana , Bergui Mauro , Cerrato Paolo , Pitrone Antonio , Grillo Francesco , Saletti Andrea , De Vito Alessandro , Gasparotti Roberto , Magoni Mauro , Puglielli Edoardo , Casalena Alfonsina , Causin Francesco , Baracchini Claudio , Castellan Lucio , Malfatto Laura , Menozzi Roberto , Scoditti Umberto , Comelli Chiara , Duc Enrica , Comai Alessio , Franchini Enrica , Cosottini Mirco , Mancuso Michelangelo , Peschillo Simone , De Michele Manuela , Giorgianni Andrea , Delodovici Maria Luisa , Lafe Elvis , Denaro Maria Federica , Burdi Nicola , Internò Saverio , Cavasin Nicola , Critelli Adriana , Chiumarulo Luigi , Petruzzellis Marco , Doddi Marco , Carolei Antonio , Auteri William , Petrone Alfredo , Padolecchia Riccardo , Tassinari Tiziana , Pavia Marco , Invernizzi Paolo , Turcato Gianni , Forlivesi Stefano , Ciceri Elisa Francesca Maria , Bonetti Bruno , Inzitari Domenico , Toni Danilo ,   on behalf of the IER Collaborators, Limbucci Nicola , Consoli Arturo , Renieri Leonardo , Fainardi Enrico , Gandini Roberto , Pampana Enrico , Diomedi Marina , Koch Giacomo , Verganti Luca , Sacchetti Federico , Zelent Gabriele , Bigliardi Guido , Picchetto Livio , Vandelli Laura , Romano Daniele Giuseppe , Cioni Samuele , Gennari Paola , Cerase Alfonso , Martini Giuseppe , Stura Guido , Daniele Dino , Naldi Andrea , Papa Rosario , Vinci Sergio Lucio , Bernava Gianmarco , Velo Mariano , Caragliano Antonio , Tessitore Agostino , Buonomo Orazio , Musolino Rossella , La Spina Paolino , Casella Carmela , Carolina Fazio Maria , Cotroneo Masina , Onofrio Marcello , Azzini Cristiano , Casetta Ilaria , Mardighian Dikran , Frigerio Michele , Costa Angelo , Di Egidio Vincenzo , Lattanzi Ruggero , Assetta Maurizio , Cester Giacomo , Mavilio Nicola , Serrati Carlo , Piazza Paolo , Epifani Enrico , Andreone Andrea , Castellini Paola , Latte Lilia , Grisendi Ilaria , Vaudano Giacomo , Comelli Simone , Cavallo Roberto , Chianale Gigliola , Simonetti Luigi , Taglialatela Francesco , Isceri Salvatore , Procaccianti Gaetano , Zaniboni Anna , Borghi Annamaria , Bonatti Giampietro , Ferro Federica , Bonatti Matteo , Dall’Ora Elisa , Currò Dossi Roberto , Turri Emanuela , Turri Mara , Puglioli Michele , Lazzarotti Guido , Lauretti Dario , Giannini Nicola , Maccarone Miriam , Orlandi Giovanni , Chiti Alberto , Guidetti Giulio , Biraschi Francesco , Falcou Anne , Anzini Alexia , Mancini Alessandra , Fausti Silvia , Di Mascio Maria Teresa , Durastanti Laura , Sbardella Emilia , Mellina Vittorio , Baruzzi Fabio , Pellegrino Carlo , Terrana Alberto , Carimati Federico , Ruggiero Maria , Sanna Antioco , Passarin Maria Grazia , Colosimo Cesare , Pedicelli Alessandro , D’Argento Francesco , Alexandre Andrea , Frisullo Giovanni , Zappoli Federico , Martignoni Alessandra , Cavallini Anna , Persico Alessandra , Valvassori Luca , Piano Mariangela , Agostoni Elio , Motto Cristina , Gatti Antonella , Longoni Marco , Guccione Angelo , Tortorella Rachele , Zampieri Piergiuseppe , Zimatore Domenico Sergio , Grazioli Andrea , Ricciardi Giuseppe Kenneth , Augelli Raffaele , Bovi Paolo , Tomelleri Giampaolo , Micheletti Nicola , Semeraro Vittorio , Lucarelli Nicola , Ganimede Maria , Tinelli Angelica , Pia Prontera Maria , Pesare Angela , Cagliari Enrico , Quatrale Rocco , Federico Francesco , Passalacqua Giovanni , Filauri Pietro , Orlandi Berardino , De Santis Federica , Gabriele Amleto , Tiseo Cindy , Armentano Antonio , Di Benedetto Olindo , Silvagni Umberto , Perrotta Paolo , Crispino Emanuela , Stancati Furio , Rizzuto Stefano , Pugliese Pierfrancesco , Pisani Ermanno , Siniscalchi Antonio , Gaudiano Carmen , Pirritano Domenico , Del Giudice Francesco , Calia Stefano , Ganci Giuseppe , Sugo Annalisa , Scomazzoni Francesco , Simionato Franco , Roveri Luisa , De Nicola Maurizio , Giannoni Mirko , Bruni Stefano , Gambelli Elena , Provinciali Leandro , Carriero Alessandro , Coppo Lorenzo , Baldan Julika , Paolo Nuzzi Nunzio , Marcheselli Simona , Corato Manuel , Cotroneo Enrico , Ricciardi Fabrizio , Gigli Renato , Pozzessere Claudio , Pezzella Francesca Romana , Corsi Fabio , Squassina Guido , Cobelli Milena , Morassi Mauro , Magni Eugenio , Pepe Fulvio , Bigni Barbara , Costa Paolo , Crabbio Massimo , Griffini Simona , Palmerini Francesco , Piras Maria Paola , Natrella Massimiliano , Fanelli Gianluca , Cristoferi Massimo , Bottacchi Edo , Corso Giovanni , Tosi Piera , Amistà Pietro , Russo Monia , Tettoni Serena , Gallesio Ivan , Mascolo Maria Carmela , Meloni Giovanni Battista , Fabio Claudio , Maiore Mario , Pintus Francesco , Pischedda Aldo , Manca Antonio , Mongili Claudia , Zanda Bastianina , Sanna Antonella , Baule Antonio , Pappalardo Maria Pia , Craparo Giuseppe , Gallo Cristina , Monaco Serena , Mannino Marina , Terruso Valeria , Muto Mario , Guarnieri Gianluigi , Andreone Vincenzo , Dui Giovanni , Ticca Anna , Salmaggi Andrea , Iannucci Giuseppe , Pinna Vittore , Di Clemente Loris , Perini Francesco , De Boni Antonella , De Luca Cristina , De Giorgi Franco , Corraine Simona , Enne Paolo , Ganau Claudio , Piras Valeria 
Published: March 2019

Background and Purpose—
As a reliable scoring system to detect the risk of symptomatic intracerebral hemorrhage after thrombectomy for ischemic stroke is not yet available, we developed a nomogram for predicting symptomatic intracerebral hemorrhage in patients with large vessel occlusion in the anterior circulation who received bridging of thrombectomy with intravenous thrombolysis (training set), and to validate the model by using a cohort of patients treated with direct thrombectomy (test set).

Methods—
We conducted a cohort study on prospectively collected data from 3714 patients enrolled in the IER (Italian Registry of Endovascular Stroke Treatment in Acute Stroke). Symptomatic intracerebral hemorrhage was defined as any type of intracerebral hemorrhage with increase of ≥4 National Institutes of Health Stroke Scale score points from baseline ≤24 hours or death. Based on multivariate logistic models, the nomogram was generated. We assessed the discriminative performance by using the area under the receiver operating characteristic curve.

Results—
National Institutes of Health Stroke Scale score, onset-to-end procedure time, age, unsuccessful recanalization, and Careggi collateral score composed the IER-SICH nomogram. After removing Careggi collateral score from the first model, a second model including Alberta Stroke Program Early CT Score was developed. The area under the receiver operating characteristic curve of the IER-SICH nomogram was 0.778 in the training set (n=492) and 0.709 in the test set (n=399). The area under the receiver operating characteristic curve of the second model was 0.733 in the training set (n=988) and 0.685 in the test set (n=779).

Conclusions—
The IER-SICH nomogram is the first model developed and validated for predicting symptomatic intracerebral hemorrhage after thrombectomy. It may provide indications on early identification of patients for more or less postprocedural intensive management.