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. 2025 Feb 4:jnis-2024-022802.
doi: 10.1136/jnis-2024-022802. Online ahead of print.

Predicting symptomatic intracranial hemorrhage after endovascular treatment of vertebrobasilar artery occlusion: PEACE score

Yingjie Xu #  1 , Andrea Maria Alexandre #  2 , Alessandro Pedicelli #  3 , Xianjun Huang  4 , Mingtong Wei  5 , Pan Zhang  1 , Miaomiao Hu  6 , Xin Chen  7 , Zhiliang Guo  8 , Juehua Zhu  9 , Hao Chen  10 , Chuyuan Ni  11 , Ligen Fan  12 , Ruyue Wang  6 , Qizhang Wang  13 , Jianshang Wen  14 , Yongliang Yang  15 , Wuwei Chu  16 , Zheng Dai  17 , Shidong Tan  18 , Aldobrando Broccolini  19 , Arianna Camilli  20 , Serena Abruzzese  21 , Carlo Cirelli  22 , Mauro Bergui  23 , Dott Andrea Romi  24 , Luca Scarcia  25 , Erwah Kalsoum  26 , Giulia Frauenfelder  27 , Grzegorz Meder  28 , Simona Scalise  29 , Maria P Ganimede  30 , Luigi Bellini  31 , Bruno Del Sette  32 , Francesco Arba  33 , Susanna Sammali  34 , Andrea Salcuni  35 , Sergio L Vinci  36 , Giacomo Cester  37 , Luisa Roveri  38 , Lei Wang  39 , Zuowei Duan  40 , Shuai Zhang  41 , Guoqiang Xu  42 , Shizhan Li  43 , Yong Liang  44 , Zongyi Wu  45 , Shengfei Qin  46 , Guanglin Luo  47 , Zhixin Huang  48 , Lulu Xiao  49 , Wen Sun  50
Affiliations

Predicting symptomatic intracranial hemorrhage after endovascular treatment of vertebrobasilar artery occlusion: PEACE score

Yingjie Xu et al. J Neurointerv Surg. .

Abstract

Background: Current clinical decision tools for assessing the risk of symptomatic intracranial hemorrhage (sICH) in patients with vertebrobasilar artery occlusion (VBAO) who received endovascular treatment (EVT) have limited performance. This study develops and validates a clinical risk score to precisely estimate the risk of sICH in VBAO patients.

Methods: The derivation cohort recruited patients with VBAO who received EVT from the Posterior Circulation IschemIc Stroke Registry in China. Based on the posterior circulation-Alberta Stroke Program Early CT Score (pc-ASPECTS) evaluation method, the cohort was further divided into non-contrast CT (NCCT) and diffusion weighted imaging (DWI) cohorts to construct predictive models. sICH was diagnosed according to the Heidelberg Bleeding Classification within 48 hours of EVT. Clinical signature was constructed in the derivation cohort using machine learning and was validated in two additional cohorts from Asia and Europe.

Results: We enrolled 1843 patients who underwent EVT and had complete data. pc-ASPECTS of 1710 patients was evaluated on NCCT and 699 patients on DWI. In the NCCT cohort, 1364 individuals made up the training set, of whom 101 (7.4%) developed sICH. In the DWI cohort, the training set consisted of 560 individuals, with 44 (7.9%) experiencing sICH. Predictors of sICH were: glucose, pc-ASPECTS, time from estimated occlusion to groin puncture (EOT), poor collateral circulation, and modified Thrombolysis in Cerebral Infarction (mTICI) score. From these predictors, we derived the weighted poor collateral circulation-EOT-pc-ASPECTS-mTICI-glucose (PEACE) score. The PEACE score showed good discrimination in the training set (area under the curve (AUC)NCCT=0.85; AUCDWI=0.86), internal validation set (AUCNCCT=0.81; AUCDWI=0.82), and two additional external validation set (Asia: AUCNCCT=0.78, AUCDWI=0.80; Europe: AUCNCCT=0.74, AUCDWI=0.78).

Conclusion: The PEACE score reliably predicted the risk of sICH in VBAO patients who underwent EVT.

Keywords: Stroke; Thrombolysis.

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Conflict of interest statement

Competing interests: None declared.

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