Top

Published in:

Open Access 01-12-2022 | Stroke | Research article

Nomogram to predict 3-month unfavorable outcome after thrombectomy for stroke

Authors: Xiao-Guang Zhang, Jia-Hui Wang, Wen-Hao Yang, Xiao-Qiong Zhu, Jie Xue, Zhi-Zhang Li, Yu-Ming Kong, Liang Hu, Shan-Shan Jiang, Xu-Shen Xu, Yun-Hua Yue

Published in: BMC Neurology | Issue 1/2022

Abstract

Background

Mechanical thrombectomy (MT) is an effective treatment for large-vessel occlusion in acute ischemic stroke, however, only some revascularized patients have a good prognosis. For stroke patients undergoing MT, predicting the risk of unfavorable outcomes and adjusting the treatment strategies accordingly can greatly improve prognosis. Therefore, we aimed to develop and validate a nomogram that can predict 3-month unfavorable outcomes for individual stroke patient treated with MT.

Methods

We analyzed 258 patients with acute ischemic stroke who underwent MT from January 2018 to February 2021. The primary outcome was a 3-month unfavorable outcome, assessed using the modified Rankin Scale (mRS), 3–6. A nomogram was generated based on a multivariable logistic model. We used the area under the receiver-operating characteristic curve to evaluate the discriminative performance and used the calibration curve and Spiegelhalter’s Z-test to assess the calibration performance of the risk prediction model.

Results

In our visual nomogram, gender (odds ratio [OR], 3.40; 95%CI, 1.54–7.54), collateral circulation (OR, 0.46; 95%CI, 0.28–0.76), postoperative mTICI (OR, 0.06; 95%CI, 0.01–0.50), stroke-associated pneumonia (OR, 5.76; 95%CI, 2.79–11.87), preoperative Na (OR, 0.82; 95%CI, 0.72–0.92) and creatinine (OR, 1.02; 95%CI, 1.01–1.03) remained independent predictors of 3-month unfavorable outcomes in stroke patients treated with MT. The area under the nomogram curve was 0.8791 with good calibration performance (P = 0.873 for the Spiegelhalter’s Z-test).

Conclusions

A novel nomogram consisting of gender, collateral circulation, postoperative mTICI, stroke-associated pneumonia, preoperative Na and creatinine can predict the 3-month unfavorable outcomes in stroke patients treated with MT.

Available only for authorised users

Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation. 2019;139(10):e56–528. https://doi.org/10.1161/CIR.0000000000000659.CrossRefPubMed

Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, et al. Stent-retriever thrombectomy after intravenous t-PA vs t-PA alone in stroke. N Engl J Med. 2015;372(24):2285–95. https://doi.org/10.1056/NEJMoa1415061.CrossRefPubMed

Zhang X, Yuan K, Wang H, Gong P, Jiang T, Xie Y, et al. Nomogram to predict mortality of endovascular thrombectomy for ischemic stroke despite successful recanalization. J Am Heart Assoc. 2020;9(3):e014899. https://doi.org/10.1161/JAHA.119.014899.CrossRefPubMedPubMedCentral

O’Connor KP, Hathidara MY, Danala G, Xu C, McCoy TM, Sidorov EV, et al. Predicting clinical outcome after mechanical thrombectomy: the GADIS (Gender, Age, Diabetes Mellitus History, Infarct Volume, and Current Smoker [corrected]) Score. World Neurosurg. 2020;134:e1130–42. https://doi.org/10.1016/j.wneu.2019.11.127.CrossRefPubMed

Ben Hassen W, Raynaud N, Bricout N, Boulouis G, Legrand L, Ferrigno M, et al. MT-DRAGON score for outcome prediction in acute ischemic stroke treated by mechanical thrombectomy within 8 hours. J Neurointerv Surg. 2020;12(3):246–51. https://doi.org/10.1136/neurintsurg-2019-015105.CrossRefPubMed

Xiao L, Jiang Y, Zhang C, Jiang L, Zhou W, Su T, et al. A novel clinical nomogram to predict bilateral hyperaldosteronism in Chinese patients with primary aldosteronism. Clin Endocrinol (Oxf). 2019;90(6):781–8. https://doi.org/10.1111/cen.13962.CrossRef

Kuo TJ, Hsu CL, Liao PH, Huang SJ, Hung YM. Yin CH Nomogram for pneumonia prediction among children and young people with cerebral palsy: a population-based cohort study. PLoS One. 2020;15(7):e0235069. https://doi.org/10.1371/journal.pone.0235069.CrossRefPubMedPubMedCentral

Tan W, Xie X, Huang Z, Chen L, Tang W, Zhu R, et al. Construction of an immune-related genes nomogram for the preoperative prediction of axillary lymph node metastasis in triple-negative breast cancer. Artif Cells Nanomed Biotechnol. 2020;48(1):288–97. https://doi.org/10.1080/21691401.2019.1703731.CrossRefPubMed

Zhao E, Xie H, Zhang Y. A nomogram based on apelin-12 for the prediction of major adverse cardiovascular events after percutaneous coronary intervention among patients with ST-segment elevation myocardial infarction. Cardiovasc Ther. 2020;2020:9416803. https://doi.org/10.1155/2020/9416803.CrossRefPubMedPubMedCentral

10.

Cappellari M, Mangiafico S, Saia V, Pracucci G, Nappini S, Nencini P, et al. IER-START nomogram for prediction of three-month unfavorable outcome after thrombectomy for stroke. Int J Stroke. 2020;15(4):412–20. https://doi.org/10.1177/1747493019837756.CrossRefPubMed

11.

Li X, Zou Y, Hu J, Li XM, Huang CP, Shan YJ, et al. A NAC nomogram to predict the probability of three-month unfavorable outcome in Chinese acute ischemic stroke patients treated with mechanical thrombectomy. Int J Neurosci. 2020;1–7. https://doi.org/10.1080/00207454.2020.1733565.

12.

Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49(3):e46–110. https://doi.org/10.1161/STR.0000000000000158.CrossRef

13.

McCarthy DJ, Diaz A, Sheinberg DL, Snelling B, Luther EM, Chen SH, et al. Long-term outcomes of mechanical thrombectomy for stroke: a meta-analysis. ScientificWorldJournal. 2019;2019:7403104. https://doi.org/10.1155/2019/7403104.CrossRefPubMedPubMedCentral

14.

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. 2018;378(1):11–21. https://doi.org/10.1056/NEJMoa1706442.CrossRefPubMed

15.

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. 2018;378(8):708–18. https://doi.org/10.1056/NEJMoa1713973.CrossRefPubMedPubMedCentral

16.

Silva GS, Lima FO, Camargo EC, Smith WS, Lev MH, Harris GJ, et al. Gender differences in outcomes after ischemic stroke: role of ischemic lesion volume and intracranial large-artery occlusion. Cerebrovasc Dis. 2010;30(5):470–5. https://doi.org/10.1159/000317088.CrossRefPubMedPubMedCentral

17.

Spaander FH, Zinkstok SM, Baharoglu IM, Gensicke H, Polymeris A, Traenka C, et al. Sex differences and functional outcome after intravenous thrombolysis. Stroke. 2017;48(3):699–703. https://doi.org/10.1161/STROKEAHA.116.014739.CrossRefPubMed

18.

Davison MA, Ouyang B, Keppetipola KM, Chen M. Arterial diameter and the gender disparity in stroke thrombectomy outcomes. J Neurointerv Surg. 2018;10(10):949–52. https://doi.org/10.1136/neurintsurg-2017-013697.CrossRefPubMed

19.

Yahalom G, Schwartz R, Schwammenthal Y, Merzeliak O, Toashi M, Orion D, et al. Chronic kidney disease and clinical outcome in patients with acute stroke. Stroke. 2009;40(4):1296–303. https://doi.org/10.1161/STROKEAHA.108.520882.CrossRefPubMed

20.

Dudev T, Lim C. Ion selectivity strategies of sodium channel selectivity filters. Acc Chem Res. 2014;47(12):3580–7. https://doi.org/10.1021/ar5002878.CrossRefPubMed

21.

Gala-Bladzinska A, Czarnota J, Kaczorowski R, Braun M, Gargasz K, Bartosik-Psujek H. Mild hyponatremia discovered within the first 24 hours of ischemic stroke is a risk factor for early post stroke mortality. Adv Clin Exp Med. 2019;28(10):1321–7. https://doi.org/10.17219/acem/103070.CrossRefPubMed

22.

Ginsberg MD. The cerebral collateral circulation: relevance to pathophysiology and treatment of stroke. Neuropharmacology. 2018;134(Pt B):280–92. https://doi.org/10.1016/j.neuropharm.2017.08.003.CrossRefPubMed

23.

Piedade GS, Schirmer CM, Goren O, Zhang H, Aghajanian A, Faber JE, et al. Cerebral collateral circulation: a review in the context of ischemic stroke and mechanical thrombectomy. World Neurosurg. 2019;122:33–42. https://doi.org/10.1016/j.wneu.2018.10.066.CrossRefPubMed

24.

Lin MP, Tsivgoulis G, Alexandrov AV, Chang JJ. Factors affecting clinical outcome in large-vessel occlusive ischemic strokes. Int J Stroke. 2015;10(4):479–84. https://doi.org/10.1111/ijs.12406.CrossRefPubMed

25.

Smith CJ, Kishore AK, Vail A, Chamorro A, Garau J, Hopkins SJ, et al. Diagnosis of stroke-associated pneumonia: recommendations from the pneumonia in stroke consensus group. Stroke. 2015;46(8):2335–40. https://doi.org/10.1161/STROKEAHA.115.009617.CrossRefPubMed

26.

de Jonge JC, Takx RAP, Kauw F, de Jong PA, Dankbaar JW, van der Worp HB. Signs of pulmonary infection on admission chest computed tomography are associated with pneumonia or death in patients with acute stroke. Stroke. 2020;51(6):1690–5. https://doi.org/10.1161/STROKEAHA.120.028972.CrossRefPubMed

27.

Yang P, Zhang Y, Zhang L, Zhang Y, Treurniet KM, Chen W, et al. endovascular thrombectomy with or without intravenous alteplase in acute stroke. N Engl J Med. 2020;382(21):1981–93. https://doi.org/10.1056/NEJMoa2001123.CrossRefPubMed

28.

Ntaios G, Faouzi M, Ferrari J, Lang W, Vemmos K. Michel P An integer-based score to predict functional outcome in acute ischemic stroke: the ASTRAL score. Neurology. 2012;78(24):1916–22. https://doi.org/10.1212/WNL.0b013e318259e221.CrossRefPubMed

29.

Strbian D, Meretoja A, Ahlhelm FJ, Pitkaniemi J, Lyrer P, Kaste M, et al. Predicting outcome of IV thrombolysis-treated ischemic stroke patients: the DRAGON score. Neurology. 2012;78(6):427–32. https://doi.org/10.1212/WNL.0b013e318245d2a9.CrossRefPubMed

30.

Sun C, Li X, Song B, Chen X, Nyame L, Liu Y, et al. A NADE nomogram to predict the probability of 6-month unfavorable outcome in Chinese patients with ischemic stroke. BMC Neurol. 2019;19(1):274. https://doi.org/10.1186/s12883-019-1464-6.CrossRefPubMedPubMedCentral

Title: Nomogram to predict 3-month unfavorable outcome after thrombectomy for stroke
Authors: Xiao-Guang Zhang
Jia-Hui Wang
Wen-Hao Yang
Xiao-Qiong Zhu
Jie Xue
Zhi-Zhang Li
Yu-Ming Kong
Liang Hu
Shan-Shan Jiang
Xu-Shen Xu
Yun-Hua Yue
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Stroke
Thrombectomy
Published in: BMC Neurology / Issue 1/2022
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/s12883-022-02633-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Nomogram to predict 3-month unfavorable outcome after thrombectomy for stroke

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2022

Recurrent headache and visual symptoms in a young man: a rare neuronal intranuclear inclusion disease case report

A predictive model for postoperative progressive haemorrhagic injury in traumatic brain injuries

Shift in diagnostic classification of migraine after initiation of preventive treatment with eptinezumab: post hoc analysis of the PROMISE studies

The potential impact of insulin resistance and metabolic syndrome on migraine headache characteristics

Neck-specific strengthening exercise compared with placebo sham ultrasound in patients with migraine: a randomized controlled trial

Systematic literature review and meta-analysis of the prevalence of secondary progressive multiple sclerosis in the USA, Europe, Canada, Australia, and Brazil