{
  "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.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurology, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China"
      ],
      "name": "Yingjie Xu"
    },
    {
      "affiliations": [
        "UOC Radiologia e Neuroradiologia, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy"
      ],
      "name": "Andrea Maria Alexandre"
    },
    {
      "affiliations": [
        "UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy"
      ],
      "name": "Alessandro Pedicelli"
    },
    {
      "affiliations": [
        "Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui, China"
      ],
      "name": "Xianjun Huang"
    },
    {
      "affiliations": [
        "Department of Hepatic Surgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China"
      ],
      "name": "Mingtong Wei"
    },
    {
      "affiliations": [
        "Department of Neurology, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China"
      ],
      "name": "Pan Zhang"
    },
    {
      "affiliations": [
        "Department of Neurology, Bengbu Medical College, Bengbu, Anhui, China"
      ],
      "name": "Miaomiao Hu"
    },
    {
      "affiliations": [
        "Department of Neurology, Northern Jiangsu People’s Hospital, Yangzhou, Jiangsu, China"
      ],
      "name": "Xin Chen"
    },
    {
      "affiliations": [
        "Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China"
      ],
      "name": "Zhiliang Guo"
    },
    {
      "affiliations": [
        "Department of Neurology, The First Affliated Hospital of Soochow University, Suzhou, Jiangsu, China"
      ],
      "name": "Juehua Zhu"
    },
    {
      "affiliations": [
        "Department of Neurology, First Affiliated Hospital of Xuzhou Medical University, Xuzhou, China"
      ],
      "name": "Hao Chen"
    },
    {
      "affiliations": [
        "Department of Neurology, Huangshan City People's Hospital, Huangshan, Anhui, China"
      ],
      "name": "Chuyuan Ni"
    },
    {
      "affiliations": [
        "Department of Neurology, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China"
      ],
      "name": "Ligen Fan"
    },
    {
      "affiliations": [
        "Department of Neurology, Bengbu Medical College, Bengbu, Anhui, China"
      ],
      "name": "Ruyue Wang"
    },
    {
      "affiliations": [
        "Department of Neurology, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, Guangdong, China"
      ],
      "name": "Qizhang Wang"
    },
    {
      "affiliations": [
        "Department of Neurology, Shucheng County People’s Hospital, Luan, Anhui, China"
      ],
      "name": "Jianshang Wen"
    },
    {
      "affiliations": [
        "Department of Neurology, Suixi County Hospital of Traditional Chinese Medicine, Huaibei, Anhui, China"
      ],
      "name": "Yongliang Yang"
    },
    {
      "affiliations": [
        "Department of Neurology, Tongcheng City People’s Hospital, Tongcheng, Anhui, China"
      ],
      "name": "Wuwei Chu"
    },
    {
      "affiliations": [
        "Department of Neurology, Wuxi People's Hospital, Wuxi, Jiangsu, China"
      ],
      "name": "Zheng Dai"
    },
    {
      "affiliations": [
        "Department of Neurology, Second Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China"
      ],
      "name": "Shidong Tan"
    },
    {
      "affiliations": [
        "Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy"
      ],
      "name": "Aldobrando Broccolini"
    },
    {
      "affiliations": [
        "Catholic University of Sacred Heart, Rome, Italy"
      ],
      "name": "Arianna Camilli"
    },
    {
      "affiliations": [
        "Catholic University School of Medicine, Rome, Italy"
      ],
      "name": "Serena Abruzzese"
    },
    {
      "affiliations": [
        "Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy"
      ],
      "name": "Carlo Cirelli"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Università degli Studi di Torino, Torino, Italy"
      ],
      "name": "Mauro Bergui"
    },
    {
      "affiliations": [
        "IRCCS Policlinico San Matteo, Pavia, Italy"
      ],
      "name": "Dott Andrea Romi"
    },
    {
      "affiliations": [
        "Diagnostic and Interventional Neuroradiology, Hospital Foch, Créteil, France"
      ],
      "name": "Luca Scarcia"
    },
    {
      "affiliations": [
        "Neuroradiology Unit, Hospital Henri Mondor, Creteil, France"
      ],
      "name": "Erwah Kalsoum"
    },
    {
      "affiliations": [
        "Neuroradiology, Neuroradiology Unit, AOU S Giovanni di Dio e Ruggi di Aragona, Salerno, Italy"
      ],
      "name": "Giulia Frauenfelder"
    },
    {
      "affiliations": [
        "Department of Interventional Radiology, Jan Biziel University Hospital No 2 in Bydgoszcz, Bydgoszcz, Poland"
      ],
      "name": "Grzegorz Meder"
    },
    {
      "affiliations": [
        "Neurology, Hospital Vito Fazzi, Lecce, Italy"
      ],
      "name": "Simona Scalise"
    },
    {
      "affiliations": [
        "Interventional Radiology, Interventional Radiology Unit, 'SS Annunziata' Hospital, Taranto, Italy"
      ],
      "name": "Maria P Ganimede"
    },
    {
      "affiliations": [
        "Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy"
      ],
      "name": "Luigi Bellini"
    },
    {
      "affiliations": [
        "IRCCS Ospedale Policlinico San Martino, Genova, Italy"
      ],
      "name": "Bruno Del Sette"
    },
    {
      "affiliations": [
        "Emergency Department, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy"
      ],
      "name": "Francesco Arba"
    },
    {
      "affiliations": [
        "Azienda Ospedaliera Universitaria Policlinico G Martino, Messina, Italy"
      ],
      "name": "Susanna Sammali"
    },
    {
      "affiliations": [
        "Radiological Sciences, Oncology, and Pathology, University of Rome La Sapienza, Rome, Italy"
      ],
      "name": "Andrea Salcuni"
    },
    {
      "affiliations": [
        "Neuroradiology Unit, Department of Radiological Sciences, University of Messina, Messina, Italy"
      ],
      "name": "Sergio L Vinci"
    },
    {
      "affiliations": [
        "Neuroradiology Unit, Policlinico Universitario di Padova, Padua, Italy"
      ],
      "name": "Giacomo Cester"
    },
    {
      "affiliations": [
        "Neurology Unit, IRCCS San Raffaele University Hospital, Milan, Italy"
      ],
      "name": "Luisa Roveri"
    },
    {
      "affiliations": [
        "Department of Neurology, Xuzhou Central Hospital, Xuzhou, Jiangsu, China"
      ],
      "name": "Lei Wang"
    },
    {
      "affiliations": [
        "Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China"
      ],
      "name": "Zuowei Duan"
    },
    {
      "affiliations": [
        "Department of Neurology, The Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, China"
      ],
      "name": "Shuai Zhang"
    },
    {
      "affiliations": [
        "Department of Neurology, First People's Hospital of Yongkang, Yongkang, Zhejiang, China"
      ],
      "name": "Guoqiang Xu"
    },
    {
      "affiliations": [
        "Department of Neurology, First People's Hospital of Yulin, Yulin, Guangxi, China"
      ],
      "name": "Shizhan Li"
    },
    {
      "affiliations": [
        "Department of Neurology, First Hospital of Changsha, Changsha, Hunan, China"
      ],
      "name": "Yong Liang"
    },
    {
      "affiliations": [
        "Department of Neurology, Hospital of Traditional Chinese Medicine of Zhongshan, Zhongshan, Guangdong, China"
      ],
      "name": "Zongyi Wu"
    },
    {
      "affiliations": [
        "Department of Neurology, Zhong Mei Kuang Jian Zong Yi Yuan, Suzhou, Anhui, China"
      ],
      "name": "Shengfei Qin"
    },
    {
      "affiliations": [
        "Department of Neurology, Funan County People's Hospital, Fuyang, Anhui, China"
      ],
      "name": "Guanglin Luo"
    },
    {
      "affiliations": [
        "Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China"
      ],
      "name": "Zhixin Huang"
    },
    {
      "affiliations": [
        "Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China"
      ],
      "name": "Lulu Xiao"
    },
    {
      "affiliations": [
        "Department of Neurology, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China"
      ],
      "name": "Wen Sun"
    }
  ],
  "title": "Predicting symptomatic intracranial hemorrhage after endovascular treatment of vertebrobasilar artery occlusion: PEACE score",
  "uid": "4278824e-4130-513e-82a8-9ca6fc72a6e3"
}