Nomogram to predict unfavorable outcome of endovascular thrombectomy for large ischemic core

IF 4.4 2区医学 Q1 CLINICAL NEUROLOGY Annals of Clinical and Translational Neurology Pub Date : 2023-06-16 DOI:10.1002/acn3.51826

Nannan Han, Xiaobo Zhang, Yu Zhang, Yu Liu, Yongqin Zhang, Haojun Ma, Hanming Ge, Shilin Li, Xiao Zhang, Xudong Yan, Tengfei Li, Bin Gao, Chengxue Du, Xinchao Ji, Wenzhen Shi, Ye Tian, Mingze Chang

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Abstract

Objective

The prognosis for patients presenting with a large ischemic core (LIC) following endovascular thrombectomy is relatively poor. This study aimed to construct and validate a nomogram for predicting 3-month unfavorable outcome in patients with anterior circulation occlusion-related LIC who underwent endovascular thrombectomy.

Methods

A retrospective training cohort and a prospective validation cohort of patients with a large ischemic core were studied. The diffusion weighted imaging related radiomic features and pre-thrombectomy clinical features were collected. After the selection of relevant features, a nomogram predicting modified Rankin Scale score of 3–6 as an unfavorable outcome was established. The discriminatory value of the nomogram was evaluated with a receiver operating characteristic curve.

Results

A total of 140 patients (mean age 66.3 ± 13.4 years, 35% female) were included in this study, consisting of a training cohort (n = 95) and a validation cohort (n = 45). The percentage of patients with an mRS scores of 0–2 was 30%, 0–3 was 40.7%, and 32.9% were dead. Age, National Institute of Health Stroke Scale (NIHSS) score, and two radiomic features, Maximum2DDiameterColumn and Maximum2DDiameterSlice, were identified as factors associated with unfavorable outcome in the nomogram. The nomogram demonstrated an area under the curve of 0.892 (95% confidence interval [CI], 0.812–0.947) in the training dataset and 0.872 (95% CI, 0.739–0.953) in the validation dataset.

Interpretation

This nomogram, which includes age, NIHSS score, Maximum2DDiameterColumn, and Maximum2DDiameterSlice, may predict the risk of unfavorable outcome in patients with LIC caused by anterior circulation occlusion.

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脑血管内取栓术对大面积缺血性心脏的不良预后

目的血管内取栓术后出现大缺血核(LIC)的患者预后较差。本研究旨在构建并验证一种预测前循环闭塞相关LIC患者接受血管内取栓术后3个月不良预后的nomogram。方法采用回顾性训练队列和前瞻性验证队列对大心肌缺血患者进行研究。收集弥散加权成像相关放射学特征及取栓前临床特征。选择相关特征后，建立预测修正Rankin量表得分为3-6分为不利结果的nomogram。用受试者工作特征曲线评价nomogram鉴别值。结果共纳入140例患者(平均年龄66.3±13.4岁，女性35%)，包括训练组(n = 95)和验证组(n = 45)。mRS评分0-2分占30%，0-3分占40.7%，死亡32.9%。年龄、美国国立卫生研究院卒中量表(NIHSS)评分和两个放射学特征Maximum2DDiameterColumn和Maximum2DDiameterSlice在nomogram中被确定为与不良结果相关的因素。模态图显示，在训练数据集中曲线下面积为0.892(95%置信区间[CI]， 0.812-0.947)，在验证数据集中曲线下面积为0.872 (95% CI, 0.739-0.953)。该nomogram包括年龄、NIHSS评分、Maximum2DDiameterColumn和Maximum2DDiameterSlice，可以预测由前循环闭塞引起的LIC患者不良结局的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Clinical and Translational Neurology Medicine-Neurology (clinical)

CiteScore

9.10

自引率

1.90%

发文量

218

审稿时长

8 weeks

期刊介绍： Annals of Clinical and Translational Neurology is a peer-reviewed journal for rapid dissemination of high-quality research related to all areas of neurology. The journal publishes original research and scholarly reviews focused on the mechanisms and treatments of diseases of the nervous system; high-impact topics in neurologic education; and other topics of interest to the clinical neuroscience community.