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Original research
Predicting symptomatic intracranial haemorrhage after mechanical thrombectomy: the TAG score
  1. Mayra Montalvo1,
  2. Eva Mistry2,
  3. Andrew Davey Chang3,
  4. Aleksandra Yakhkind1,
  5. Katarina Dakay1,
  6. Idrees Azher1,
  7. Ashutosh Kaushal1,
  8. Akshitkumar Mistry4,
  9. Rohan Chitale2,
  10. Shawna Cutting3,
  11. Tina Burton3,
  12. Brian Mac Grory3,
  13. Michael Reznik3,
  14. Ali Mahta3,
  15. Bradford B Thompson5,
  16. Koto Ishida6,
  17. Jennifer Frontera6,
  18. Howard A Riina7,
  19. David Gordon7,
  20. David Parella6,
  21. Erica Scher6,
  22. Jeffrey Farkas8,9,
  23. Ryan McTaggart10,
  24. Pooja Khatri11,
  25. Karen L Furie3,
  26. Mahesh Jayaraman5,
  27. Shadi Yaghi12
  1. 1 Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
  2. 2 Neurology, Vanderbilt University, Nashville, Tennessee, USA
  3. 3 Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
  4. 4 Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  5. 5 Neurology, Rhode Island Hospital, Providence, Rhode Island, USA
  6. 6 Neurology, NYU, New York City, New York, USA
  7. 7 Department of Neurosurgery, New York University Langone Medical Center, New York City, New York, USA
  8. 8 Neurology & Neurosurgery, NYU Langone Health, Brooklyn, New York, USA
  9. 9 Neurointerventional Surgery, Interventional Neuro Associates, Bergenfield, New Jersey, USA
  10. 10 Radiology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
  11. 11 Neurology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
  12. 12 Neurology, Columbia University Medical Center, New York City, New York, USA
  1. Correspondence to Dr Shadi Yaghi, Neurology, Columbia University Medical Center, New York, NY 11220, USA; shadiyaghi{at}yahoo.com

Abstract

Background There is limited data on predictors of symptomatic intracranial haemorrhage (sICH) in patients who underwent mechanical thrombectomy. In this study, we aim to determine those predictors with external validation.

Methods We evaluated mechanical thrombectomy in a derivation cohort of patients at a comprehensive stroke centre 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 χ2 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 an sICH prediction score. This score was then validated using data from the Blood Pressure After Endovascular Treatment multicentre prospective registry.

Results We identified 578 patients with acute ischaemic stroke who received thrombectomy, 19 had sICH (3.3%). Predictive factors of sICH were: thrombolysis in cerebral ischaemia (TICI) score, Alberta stroke program early CT score (ASPECTS), and glucose level, and from these predictors, we derived the weighted TICI-ASPECTS-glucose (TAG) score, which was associated with sICH in the derivation (OR per unit increase 1.98, 95% CI 1.48 to 2.66, p<0.001, area under curve ((AUC)=0.79) and validation (OR per unit increase 1.48, 95% CI 1.22 to 1.79, p<0.001, AUC=0.69) cohorts.

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

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Footnotes

  • MM and EM are co-first authors.

  • Contributors MM, EM, AY, KD, IA, AK, AM and RC: Data collection and manuscript revision. ADC: Data analysis and manuscript revision. SC, TB, BMG, MR, AM, BBT, RMT, MJ, KI, JF, HAR, DG, DP, ES, JF, KFL, and PK: study concept and design, and manuscript revision. SY: Study concept and design, drafting manuscript and full responsibility of data.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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