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Current Neurovascular Research

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ISSN (Print): 1567-2026
ISSN (Online): 1875-5739

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Research Article

A Nomogram Prediction Model Based on Tissue Window for the Prognosis of Patients with Acute Ischemic Stroke Undergoing Thrombectomy

Author(s): Jie-ji Zhao, Hui-ru Chen, Jun-yi Cui, Meng-fan Ye, Tan Li, Xiu-Ying Cai, Lin-qing Ma, Run-ping Zhang and Yan Kong*

Volume 20, Issue 1, 2023

Published on: 02 February, 2023

Page: [23 - 34] Pages: 12

DOI: 10.2174/1567202620666221220090548

Price: $65

Abstract

Objective: Thrombectomy greatly improves the clinical prognosis of patients with acute ischemic stroke (AIS). The aim of this study is to develop a nomogram model that can predict the prognosis of patients with acute ischemic stroke undergoing thrombectomy.

Methods: We retrospectively collected information of patients with acute ischemic stroke who were admitted to the stroke Green Channel of the First Affiliated Hospital of Soochow University from September 2018 to May 2022. The main outcome was defined as a three-month unfavorable outcome (modified Rankin Scale 3-6). Based on the results of multivariate regression analysis, a nomogram was established. We tested the accuracy and discrimination of our nomogram by calculating the consistency index (C-index) and plotting the calibration curve.

Results: National Institutes of Health Stroke Scale (NIHSS) score (OR, 1.418; 95% CI, 1.177-1.707; P＜0.001), low density lipoprotein cholesterol (LDL-C) (OR, 2.705; 95% CI, 1.203-6.080; P = 0.016), Alberta Stroke Program Early Computed Tomography Score (ASPECTS) (OR, 0.633; 95% CI, 0.421-0.952; P = 0.028), infarct core volume (OR, 1.115; 95% CI, 1.043-1.192; P = 0.001) and ischemic penumbra volume (OR, 1.028; 95% CI, 1.006-1.050; P = 0.012) were independent risk factors for poor clinical prognosis of AIS patients treated with thrombectomy. The C-index of our nomogram was 0.967 and the calibration plot revealed a generally fit in predicting three-month unfavorable outcomes. Based on this nomogram, we stratified the risk of thrombectomy population. We found that low-risk population is less than or equal to 65 points, and patients of more than 65 points tend to have a poor clinical prognosis.

Conclusion: The nomogram, composed of NIHSS, LDL-C, ASPECTS, infarct core volume and ischemic penumbra volume, may predict the clinical prognosis of cerebral infarction patients treated with thrombectomy.

« Previous Next »
[1]
Berkhemer OA, Fransen PSS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372(1): 11-20.
[http://dx.doi.org/10.1056/NEJMoa1411587] [PMID: 25517348]
[2]
Ganesh A, Goyal M. Thrombectomy for acute ischemic stroke: recent insights and future directions. Curr Neurol Neurosci Rep 2018; 18(9): 59.
[http://dx.doi.org/10.1007/s11910-018-0869-8] [PMID: 30033493]
[3]
Campbell BCV, van Zwam WH, Goyal M, et al. Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data. Lancet Neurol 2018; 17(1): 47-53.
[http://dx.doi.org/10.1016/S1474-4422(17)30407-6] [PMID: 29263006]
[4]
Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: A meta-analysis of individual patient data from five randomised trials. Lancet 2016; 387(10029): 1723-31.
[http://dx.doi.org/10.1016/S0140-6736(16)00163-X] [PMID: 26898852]
[5]
Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015; 372(24): 2285-95.
[http://dx.doi.org/10.1056/NEJMoa1415061] [PMID: 25882376]
[6]
Campbell BCV, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015; 372(11): 1009-18.
[http://dx.doi.org/10.1056/NEJMoa1414792] [PMID: 25671797]
[7]
Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: A guideline for healthcare professionals from the american heart association/american stroke association. Stroke 2019; 50(12): e344-418.
[http://dx.doi.org/10.1161/STR.0000000000000211] [PMID: 31662037]
[8]
Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med 2018; 378(1): 11-21.
[http://dx.doi.org/10.1056/NEJMoa1706442] [PMID: 29129157]
[9]
Tekle WG, Hassan AE, Jadhav AP, et al. Impact of periprocedural and technical factors and patient characteristics on revascularization and outcome in the DAWN trial. Stroke 2020; 51(1): 247-53.
[http://dx.doi.org/10.1161/STROKEAHA.119.026437] [PMID: 31744425]
[10]
Khandelwal P, Yavagal DR, Sacco RL. Acute Ischemic Stroke Intervention. J Am Coll Cardiol 2016; 67(22): 2631-44.
[http://dx.doi.org/10.1016/j.jacc.2016.03.555] [PMID: 27256835]
[11]
Albers GW, Marks MP, Kemp S, et al. Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. N Engl J Med 2018; 378(8): 708-18.
[http://dx.doi.org/10.1056/NEJMoa1713973] [PMID: 29364767]
[12]
Deng QW, Gong PY, Chen XL, et al. Admission blood cell counts are predictive of stroke-associated infection in acute ischemic stroke patients treated with endovascular therapy. Neurol Sci 2021; 42(6): 2397-409.
[http://dx.doi.org/10.1007/s10072-020-04827-2] [PMID: 33057978]
[13]
Yuan K, Chen J, Xu P, et al. A Nomogram for predicting stroke recurrence among young adults. Stroke 2020; 51(6): 1865-7.
[http://dx.doi.org/10.1161/STROKEAHA.120.029740] [PMID: 32390546]
[14]
Wang Y, Zhou X, Luo Y. Predicting value of fibrinogen in identifying cerebrovascular ischemic events in patients with dizziness/vertigo. Neurol Sci 2022; 43(2): 1105-13.
[http://dx.doi.org/10.1007/s10072-021-05363-3] [PMID: 34131814]
[15]
Iasonos A, Schrag D, Raj GV, Panageas KS. How to build and interpret a nomogram for cancer prognosis. J Clin Oncol 2008; 26(8): 1364-70.
[http://dx.doi.org/10.1200/JCO.2007.12.9791] [PMID: 18323559]
[16]
Cappellari M, Turcato G, Forlivesi S, et al. The START nomogram for individualized prediction of the probability of unfavorable outcome after intravenous thrombolysis for stroke. Int J Stroke 2018; 13(7): 700-6.
[http://dx.doi.org/10.1177/1747493018765490] [PMID: 29540109]
[17]
Cappellari M, Turcato G, Forlivesi S, et al. STARTING-SICH Nomogram to predict symptomatiC intracerebral hemorrhage after intravenous thrombolysis for stroke. Stroke 2018; 49(2): 397-404.
[http://dx.doi.org/10.1161/STROKEAHA.117.018427] [PMID: 29311264]
[18]
Wang C, Zhang X, Wu Y, Fu L, Fang Q. Clinical predictors for functional independence after tissue-window guided endovascular thrombectomy. World Neurosurg 2021; 146: e947-54.
[http://dx.doi.org/10.1016/j.wneu.2020.11.047] [PMID: 33217590]
[19]
Chen X, Huang Q, Deng Q, et al. A prediction model of brain edema after endovascular treatment in patients with acute ischemic stroke. J Neurol Sci 2019; 407: 116507.
[http://dx.doi.org/10.1016/j.jns.2019.116507] [PMID: 31644991]
[20]
Zhang X, Yuan K, Wang H, et al. Nomogram to predict mortality of endovascular thrombectomy for ischemic stroke despite successful recanalization. J Am Heart Assoc 2020; 9(3): e014899.
[http://dx.doi.org/10.1161/JAHA.119.014899] [PMID: 31973604]
[21]
Li Z, Liu Q, Liu F, et al. Nomogram to predict lefT atrial thrombus or spontaneous echo contrast in patients with non-valvular atrial fibrillation. Front Cardiovasc Med 2021; 8: 737551.
[http://dx.doi.org/10.3389/fcvm.2021.737551] [PMID: 34722669]
[22]
Zhang X, Peng M, Feng C, et al. Nomogram predicting early neurological improvement in ischaemic stroke patients treated with endovascular thrombectomy. Eur J Neurol 2021; 28(1): 152-60.
[http://dx.doi.org/10.1111/ene.14510] [PMID: 32897575]
[23]
Cappellari M, Mangiafico S, Saia V, et al. IER-SICH nomogram to predict symptomatic intracerebral hemorrhage after thrombectomy for stroke. Stroke 2019; 50(4): 909-16.
[http://dx.doi.org/10.1161/STROKEAHA.118.023316] [PMID: 31233386]
[24]
Kwah LK, Diong J. National institutes of health stroke scale (NIHSS). J Physiother 2014; 60(1): 61.
[http://dx.doi.org/10.1016/j.jphys.2013.12.012] [PMID: 24856948]
[25]
Cheng Z, Geng X, Rajah GB, et al. NIHSS Consciousness score combined with ASPECTS is a favorable predictor of functional outcome post endovascular recanalization in stroke patients. Aging Dis 2021; 12(2): 415-24.
[http://dx.doi.org/10.14336/AD.2020.0709] [PMID: 33815874]
[26]
Kim-Tenser M, Mlynash M, Lansberg MG, et al. CT perfusion core and ASPECT score prediction of outcomes in DEFUSE 3. Int J Stroke 2021; 16(3): 288-94.
[http://dx.doi.org/10.1177/1747493020915141] [PMID: 32233746]
[27]
Hill MD, Demchuk AM, Goyal M, et al. Alberta Stroke Program early computed tomography score to select patients for endovascular treatment: Interventional Management of Stroke (IMS)-III Trial Stroke 2014; 45(2): 444-9.
[http://dx.doi.org/10.1161/STROKEAHA.113.003580] [PMID: 24335227]
[28]
Psychogios MN, Schramm P, Frölich AM, et al. Alberta Stroke Program Early CT Scale evaluation of multimodal computed tomography in predicting clinical outcomes of stroke patients treated with aspiration thrombectomy. Stroke 2013; 44(8): 2188-93.
[http://dx.doi.org/10.1161/STROKEAHA.113.001068] [PMID: 23715960]
[29]
Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015; 372(11): 1019-30.
[http://dx.doi.org/10.1056/NEJMoa1414905] [PMID: 25671798]
[30]
Jiang L, Peng M, Chen H, et al. Diffusion-weighted imaging (DWI) ischemic volume is related to FLAIR hyperintensity-DWI mismatch and functional outcome after endovascular therapy. Quant Imaging Med Surg 2020; 10(2): 356-67.
[http://dx.doi.org/10.21037/qims.2019.12.05] [PMID: 32190562]
[31]
Sarraj A, Hassan AE, Grotta J, et al. Optimizing patient selection for endovascular treatment in acute ischemic stroke (SELECT): A prospective, multicenter cohort Study of imaging selection. Ann Neurol 2020; 87(3): 419-33.
[http://dx.doi.org/10.1002/ana.25669] [PMID: 31916270]
[32]
Campbell BCV, Majoie CBLM, Albers GW, et al. Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data. Lancet Neurol 2019; 18(1): 46-55.
[http://dx.doi.org/10.1016/S1474-4422(18)30314-4] [PMID: 30413385]
[33]
Moonis M, Kane K, Schwiderski U, Sandage BW, Fisher M. HMG-CoA reductase inhibitors improve acute ischemic stroke outcome. Stroke 2005; 36(6): 1298-300.
[http://dx.doi.org/10.1161/01.STR.0000165920.67784.58] [PMID: 15879346]
[34]
Bellosta S, Fed N, Bernini F, Paoletti R, Corsini A. Non-lipid-related effects of statins. Ann Med 2000; 32(3): 164-76.
[http://dx.doi.org/10.3109/07853890008998823] [PMID: 10821323]
[35]
Amarenco P, Kim JS, Labreuche J, et al. A Comparison of two LDL cholesterol targets after ischemic stroke. N Engl J Med 2020; 382(1): 9-19.
[http://dx.doi.org/10.1056/NEJMoa1910355] [PMID: 31738483]

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