Good afternoon. My name is David Dornbos. I'm a current open and endovascular fellow here at Sims Murphy Clinic in Memphis, Tennessee, and I'll be discussing our validation of the TAG score as a predictive model for symptomatic intracranial hemorrhage following mechanical thrombectomy. Just to start off with, as we all know, mechanical thrombectomy for acute ischemic stroke, secondary to large vessel occlusion, has been found to be highly efficacious. It does carry approximately a 6% risk of symptomatic intracranial hemorrhage, and the predictors of this adverse event remain largely unstudied. To this end, the TAG score was developed to predict which patients would develop symptomatic intracranial hemorrhage following thrombectomy. The various components of the TAG score included modified TICI results following mechanical thrombectomy, aspect scores on admission, and glucose scores of greater than or equal to 150 on initial presentation. The scoring system was internally validated in this initial study. Looking at the specific components of the TAG score itself, patients with a TICI result of 0 to 2a carried a 5-fold increase in their risk of developing symptomatic intracranial hemorrhage following the procedure. Aspect scores of less than 6 and aspect scores of 6 to 7 carried a 10 and 3-fold increased risk of symptomatic intracranial hemorrhage, and glucose greater than or equal to 150 carried a 3-fold increase in symptomatic intracranial hemorrhage following the procedure. Using these odds ratios, a scoring system was developed to predict which patients would ultimately suffer from intracranial hemorrhage following mechanical thrombectomy. To assess the predictive potential of this model, the validation cohort was found to have an area under the curve of 0.69, indicating that it is a good model for predicting which patients will ultimately develop this adverse outcome. This initial study also stratified their patients into risk groups of low, intermediate, and high risk, which were found to have a 5, 10, and 24% risk of ultimately developing symptomatic intracranial hemorrhage following mechanical thrombectomy. We sought to externally validate this model in our patients. We performed a retrospective review of 420 consecutive patients treated with mechanical thrombectomy for acute ischemic stroke between 2014 and 2017. We collected baseline demographics, admission factors, procedural metrics, and both functional and radiographic outcomes. We collected the various tag score components, and we performed statistical analysis, including both univariate and logistic regression analysis, and area under the receiver operating curve to assess the predictive potential of the model. We found no significant difference between the baseline characteristics of patients that ultimately suffered from symptomatic intracranial hemorrhage and those that did not, with the one exception being diabetes, which is accounted for in the tag score itself. Looking at the specific components of the tag score, we found no significant association between the TICI results or glucose on admission and ultimately developing symptomatic intracranial hemorrhage. We did find a significant association between ASPEC scores and patients that ultimately developed symptomatic intracranial hemorrhage. ASPEC scores with a median of 8 were found in patients that suffered from symptomatic intracranial hemorrhage, whereas the median ASPEC score in patients that did not was 10. This was associated with an odds ratio of 1.57. Looking at the overall tag score, this was also found to be associated with symptomatic intracranial hemorrhage, and this carried an odds ratio of 1.46. To assess the predictive potential of the tag score in our patient population, we found the area under the curve to be 0.633, indicating that it is a fair model in terms of predicting which patients will ultimately suffer from symptomatic intracranial hemorrhage. We did stratify our patients into their risk categories and found a similar result of 5, 10, and 33 percent risk of symptomatic intracranial hemorrhage in the low, intermediate, and high risk groups respectively. In conclusion, we found that the tag score adequately predicts symptomatic intracranial hemorrhage following mechanical thrombectomy and appropriately stratifies individual patient risk. However, additional predictors of symptomatic intracranial hemorrhage would likely yield a more robust and predictive model. Thank you.

TAG score

symptomatic intracranial hemorrhage

mechanical thrombectomy

acute ischemic stroke

modified TICI results