Affiliation:
1. School of Medicine,Chongqing University
2. Southwest Hospital, Third Military Medical University (Army Medical University)
3. Zigong Third People's Hospital
Abstract
Abstract
Background
Malignant cerebral edema (MCE) is a common and feared complication after endovascular thrombectomy (EVT) in acute ischemic stroke (AIS). This study aimed to establish a nomogram to predict MCE in anterior circulation large vessel occlusion stroke (LVOS) patients receiving EVT.
Methods
In this retrospective cohort study, 381 patients with anterior circulation LVOS receiving EVT were screened from 636 hospitalized patients with LVOS in two stroke medical centers. Clinical baseline data and imaging data were collected within 2–5 days of admission to the hospital. The patients were divided into two groups based on whether MCE occurred after EVT. Multivariate logistic regression analysis was used to evaluate the independent risk factors for MCE and to establish a nomogram.
Results
Sixty-six patients out of 381 (17.32%) developed MCE. The independent risk factors for MCE included admission NIHSS ≥ 16 (OR, 1.851; 95% CI: 1.029–3.329; P = 0.038), ASPECT score (OR, 0.621; 95% CI: 0.519–0.744; P < 0.001), right hemisphere (OR, 1.636; 95% CI :0.941–2.843; P = 0.079), collateral circulation (OR, 0.155; 95% CI: 0.074–0.324; P < 0.001), recanalization (OR, 0.223; 95% CI: 0.109–0.457; P < 0.001), hematocrit (OR, 0.937; 95% CI: 0.892–0.985; P = 0.010) and glucose (OR, 1.118; 95% CI: 1.023–1.223; P = 0.036), which were adopted as parameters of the nomogram. The receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of the nomogram in predicting MCE was 0.901(95%CI:0.848–0.940; P < 0.001). The Hosmer-Lemeshow test results were not significant (P = 0.685), demonstrating a good calibration of the nomogram.
Conclusion
The novel nomogram composed of admission NIHSS, ASPECT scores, right hemisphere, collateral circulation, recanalization, hematocrit and serum glucose provide a potential predictor for MCE in patients with AIS after EVT.
Registration:
URL: http://www.chictr.org.cn/; Unique Identifier: ChiCTR2200059412.
Publisher
Research Square Platform LLC
Reference46 articles.
1. Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S, et al. Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. N Engl J Med [Internet]. 2018;378:708–18. Available from: http://dx.doi.org/10.1056/NEJMoa1713973.
2. Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, et al. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med [Internet]. 2018;378:11–21. Available from: http://dx.doi.org/10.1056/NEJMoa1706442.
3. Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med [Internet]. 2015;372:1009–18. Available from: http://dx.doi.org/10.1056/NEJMoa1414792.
4. Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med [Internet]. 2015;372:11–20. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25517348.
5. Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet [Internet]. 2016;387:1723–31. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26898852.