This score may be useful for evaluating secondary prevention and stratifying patients in the context of even clinical trials.Ĭarotid atherosclerotic plaque is closely associated with cerebral white matter lesions (WMLs), while intraplaque neovascularization (IPN) contributes significantly to arterial remodeling and plaque vulnerability. Our score has good accuracy in identifying patients at higher risk of HT. Male gender (1 point), NIH Stroke Scale at admission ≥ 5 points (1), blood glucose at admission ≥ 160 mg/dL (1), and cardioembolism (2) were independently associated with HT. We included 952 patients in the final analysis. Independent variables identified in a logistic regression analysis were used to produce a predictive grading score. All patients underwent CT scan or MRI at admission and a follow-up neuroimaging within seven days. We retrospectively evaluated data of patients diagnosed with PC stroke not treated with RT from 5 Comprehensive Stroke Centers (four in Brazil, 1 in the US) from 2015 to 2018. We propose a scoring system to assess the HT risk in PC stroke patients not submitted to RT. Many predictive scores of this complication have been proposed, but none is designed specifically for PC stroke patients – therefore, patients who are not eligible for reperfusion therapies (RT) represent about 80% of hospitalized cases. Hemorrhagic Transformation (HT) is a dreaded complication among stroke patients. Posterior Circulation (PC) stroke represents one-fifth of all ischemic strokes, with peculiar physiological characteristics. Andrade's visiting scholarship at Columbia University, USA, is sponsored by the CAPES Foundation, Ministry of Education, Brazil. The authors state not disclosures related to the main subject of this research. A free computerized version was made publicly available. In conclusion, the PROpHET is a simple, quick, cost-free, and easy-to-perform tool that allows feasible risk stratification of HT in patients not submitted to RT. 6, 12, 13 The pathophysiology of HT in patients not treated with RT Conclusions 4 Despite the relatively high incidence of HT in patients not treated with RT, there are few predictive scores focusing in this patient population and all of them included patients submitted to RT. In low and middle-income countries, this group of patients represents up to 98% of all cases of AIS. The PROpHET is an accurate and easy-to-use predictive score of a dreaded neurological complication in patients not treated with RT. The optimal cutpoint determined by the Youden's test was also 3. There was no statistical difference in the AUROCs between the derivation and validation cohorts. In this group, the median of score was 3 and 0 points in patients with and without HT, respectively (p < 0.001), Fig. A total of 2,683 patients were retrospectively selected for the validation group, 538 patients from our institution and 2,145 from the other six CSC.įor the 448 patients included in the derivation cohort, the ValidationĪ total of 2,683 patients from seven different CSC were included in the validation cohort. The validation cohort was comprised of all other patients not included in the derivation cohort during the same time Resultsįrom 2,432 patients with acute ischemic stroke admitted to our institution from February 2015 to October 2017, 577 underwent reperfusion therapy, 734 were excluded due to inadequate imaging or refusal of consent, and 448 were prospectively randomly selected for the derivation cohort. At each admission, a random number generator was used to determine whether the patient would be included in the derivation cohort. We prospectively generated a random sample of these patients to be followed over time. Furthermore, these patients represent the majority of stroke patients since PatientsĪll patients with a diagnosis of ischemic stroke not treated with RT admitted to a Comprehensive Stroke Center from February 2015 to October 2017 were eligible. 1 Much better studied in patients treated with reperfusion therapies (RT), HT is no less important in patients not treated with RT with an incidence that reaches 43%, with approximately 20% being associated with neurological worsening1, 2, 3. Hemorrhagic transformation (HT) a complication of ischemic stroke strongly associated with neurological deterioration, short and long-term disability, as well as death.
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