Predicting Symptomatic Intracranial Hemorrhage After Mechanical Thrombectomy: The TAG Score
Mayra Montalvo 1, Eva Mistry2, Andrew Chang1, Aleksandra Yakhkind3, Katarina Dakay4, Idrees Azher5, Akshitkumar Mistry6, Rohan Chitale6, Shawna Cutting1, Tina Burton1, Brian Mac Grory1, Michael Reznik1, Ali Mahta1, Bradford Thompson1, Koto Ishida7, Jennifer Frontera8, Howard Riina9, David Gordon9, David Turkel-Parrella9, Erica Scher9, Jeffrey Farkas9, Ryan A McTaggart1, Pooja Khatri10, Karen Furie1, Mahesh Jayaraman1, Shadi Yaghi11
1Brown University, 2VanderbiltVanderbilt University Medical Center, 3University of Pennsylvania, 4New York Medical College, Westchester Medical Center, 5Rhode Island Hospital, 6Vanderbilt University Medical Center, 7NYU, 8Cleveland Clinic, 9New York Langone Medical Center, 10Univ of Cincinnati/Dept of Neuro, 11New York Langone Hospital
Objective:

We aim to determine predictors of symptomatic intracranial hemorrhage (sICH)  those predictors with external validation.

Background:

While predictors of sICH are well established, there is limited data in patients who underwent mechanical thrombectomy. 

Design/Methods:

We evaluated mechanical thrombectomy in a derivation cohort of patients at a comprehensive stroke center over a 30-month period. Clinical and radiographic data on these patients were obtained from the prospective quality improvement database. sICH was defined using the European Cooperative Acute Stroke Study III. We compared clinical and radiographic characteristics between patients with and without sICH using chi-square and t-tests to identify independent predictors of sICH with p < 0.1. Significant variables were then combined in a multivariate logistic regression model to derive a sICH prediction score. This score was then validated using data from the Blood Pressure After Endovascular Treatment (BEST) multicenter prospective registry.

Results:

We identified 578 patients with acute ischemic stroke who received thrombectomy, 19 had sICH (3.3%). Predictive factors of sICH were: Thrombolysis in cerebral ischemia score (TICI; OR: 5.00 per unit decrease; 95% CI: 1.85-14.29; p = 0.002), Alberta stroke program early computed tomography score  (ASPECTS; OR 1.52 per 1 point decrease; 95% CI: 1.15-2.00;.p = 0.003), and Glucose level (OR per 10 mg/dL increase 1.07 per mg/dL increase; 95% CI: 1.01-1.13; p = 0.018), and using the OR of the predictors in the multivariable model, we derived the weighted TAG score which was associated with sICH in the derivation (OR per unit increase 1.98, 95% CI 1.48-2.66, p<0.001, AUC=0.79) and validation (OR per unit increase 1.48, 95% CI 1.22-1.79, p<0.001, AUC=0.69) cohorts.

Conclusions:

High TAG scores are associated with sICH in patients receiving mechanical thrombectomy. Larger studies are needed to validate this scoring system and test interventions and strategies to reduce sICH risk and make thrombectomy safer in patients with elevated TAG scores.