Xiangliang Chen1, Qing Huang1, Qiwen Deng1, Rui Shen1, Yukai Liu1, Min Lu1, Hongchao Shi1, Junshan Zhou2. 1. Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China. 2. Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China. Electronic address: zhjsh333@126.com.
Abstract
BACKGROUND: Clinical tools predicting brain edema after reperfusion therapy in acute ischemic stroke are scarce. We aim to develop a nomogram model to predict brain edema within the first 24 h after endovascular treatment (EVT) in the anterior cerebral circulation. METHODS: A total of 199 patients were retrospectively identified in a single-center stroke registry. Brain edema was measured by midline shift (MLS). The associations between MLS and early neurologic outcomes were described. A nomogram predicting MLS was developed and internally validated. The nomogram was also compared with an available model using the area under the receiver operating characteristic curve (AUC) and decision curve analyses. RESULTS: Overall, 87 patients (43.7%) had MLS. The patients with MLS ≥ 6 mm showed progressive neurological deterioration according to repeated measures analysis of variance. Each millimeter increase in MLS was strongly correlated with the presence of in-hospital death or forgoing treatment (Spearman's rho = 0.429, P < .001). Patients with brain edema were less likely to have functional independence at 3 months (19.5% vs. 46.8%, P < .001). A nomogram model including 24-h CT ASPECT scores and cisternal effacement, hypertension and complete recanalization showed a C-index of 0.874. This tool exhibited a higher AUC and higher net benefit than the available model. CONCLUSIONS: This study showed a profound association between MLS and early neurologic outcomes. A nomogram model was developed to predict patients at risk of brain edema after EVT in the anterior cerebral circulation.
BACKGROUND: Clinical tools predicting brain edema after reperfusion therapy in acute ischemic stroke are scarce. We aim to develop a nomogram model to predict brain edema within the first 24 h after endovascular treatment (EVT) in the anterior cerebral circulation. METHODS: A total of 199 patients were retrospectively identified in a single-center stroke registry. Brain edema was measured by midline shift (MLS). The associations between MLS and early neurologic outcomes were described. A nomogram predicting MLS was developed and internally validated. The nomogram was also compared with an available model using the area under the receiver operating characteristic curve (AUC) and decision curve analyses. RESULTS: Overall, 87 patients (43.7%) had MLS. The patients with MLS ≥ 6 mm showed progressive neurological deterioration according to repeated measures analysis of variance. Each millimeter increase in MLS was strongly correlated with the presence of in-hospital death or forgoing treatment (Spearman's rho = 0.429, P < .001). Patients with brain edema were less likely to have functional independence at 3 months (19.5% vs. 46.8%, P < .001). A nomogram model including 24-h CT ASPECT scores and cisternal effacement, hypertension and complete recanalization showed a C-index of 0.874. This tool exhibited a higher AUC and higher net benefit than the available model. CONCLUSIONS: This study showed a profound association between MLS and early neurologic outcomes. A nomogram model was developed to predict patients at risk of brain edema after EVT in the anterior cerebral circulation.
Authors: Marie Luby; José G Merino; Rachel Davis; Saeed Ansari; Marc Fisher; Amie W Hsia; Yongwoo Kim; Lawrence L Latour; Evan S McCreedy; Rena Sukhdeo Singh; Clinton B Wright; John K Lynch Journal: Cerebrovasc Dis Date: 2021-12-13 Impact factor: 3.104
Authors: Panagiotis Mastorakos; Nicole Mihelson; Marie Luby; Scott R Burks; Kory Johnson; Amie W Hsia; Jaclyn Witko; Joseph A Frank; Lawrence Latour; Dorian B McGavern Journal: Nat Neurosci Date: 2021-01-18 Impact factor: 24.884