Predicting parenchymal hematoma associated with endovascular thrombectomy for acute occlusion of anterior circulation large vessel: the GuEss-MALiGn scale

Abstract

Background: Endovascular thrombectomy (EVT) is an emergency treatment for stroke caused by anterior circulation large vessel occlusion (ACLVO). This study aimed to identify the predictors for post-EVT parenchymal hematoma (PH) and to develop a predictive tool using the identified factors. Methods: Using the clinical and imaging data of consecutive patients with acute ACLVO who underwent EVT, we performed a multivariate binary logistic regression analysis to identify predictors for PH. With the predictors proved by the regression, we developed a scale for predicting PH using receiver operating characteristic (ROC) curve analyses. Results: In 233 enrolled patients, the mean age was 72.3 years old, and the male proportion was 46.4%. The rate of PH after EVT was 18.0%: the rate of type 1 PH was 12.9%, and the rate of type 2 PH was 5.2%. The significant predictors for PH were basal ganglia involvement, embolism, male sex, antihyperlipidemic use, lobar infarction, and serum glucose level. We developed the GuEss-MALiGn scale with the six significant predictors. Each of these six items was placed on a Likert scale and scored as a 0 or 1. The ROC curve analysis revealed that the area under the curve was 0.771. The cutoff score for the risk of PH was >3. The sensitivity was 59.5%, and the specificity was 78.0%. Conclusion: We propose the GuEss-MALiGn scale as a tool for predicting PH associated with EVT. Future external validation is needed to determine the reliability of this scale.