Deans' stroke musings: A nomogram predicts early neurological deterioration after mechanical thrombectomy in patients with ischemic stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, October 5, 2023

A nomogram predicts early neurological deterioration after mechanical thrombectomy in patients with ischemic stroke

ABSOLUTELY USELESS! Predicting failure to recover does nothing to help survivors! I'd fire you all!

A nomogram predicts early neurological deterioration after mechanical thrombectomy in patients with ischemic stroke

Kongyuan Wu¹^†

Zhengzhou Yuan^1,2^†

Wenhuo Chen³

Tingyu Yi³

Xiwen Chen¹

Mengmeng Ma¹

Jian Guo¹

Muke Zhou¹

Ning Chen¹^*

Li He¹^*

¹Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
²Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
³Department of Neurology, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China

Introduction: Early neurological deterioration (END) is common in acute ischemic stroke and is directly associated with poor outcome after stroke. Our aim is to develop and validate a nomogram to predict the risk of END after mechanical thrombectomy (MT) in acute ischemic stroke patients with anterior circulation large-vessel occlusion.

Methods: We conducted a real-world, multi-center study in patients with stroke treated with mechanical thrombectomy. END was defined as a worsening by 2 or more NIHSS points within 72-hour after stroke onset compared to admission. Multivariable logistic regression was used to determine the independent predictors of END, and the discrimination of the scale was assessed using the C-index. Calibration curves were constructed to evaluate the calibration of the nomogram, and decision curves were used to describe the benefits of using the nomogram.

Results: A total of 1007 patients were included in our study. Multivariate logistic regression analysis found age, admission systolic blood pressure, initial NIHSS scores, history of hyperlipemia, and location of occlusion were independent predictors of END. We developed a nomogram that included these 6 factors, and it revealed a prognostic accuracy with a C-index of 0.678 in the derivation group and 0.650 in the validation group. The calibration curves showed that the nomogram provided a good fit to the data, and the decision curves demonstrated a large net benefit.

Discussion: Our study established and validated a nomogram to stratify the risk of END before mechanical embolectomy and identify high-risk patients, who should be more cautious when making clinical decisions.

1. Introduction

Mechanical thrombectomy (MT) has been proven to be an effective treatment for acute ischemic stroke (AIS) with anterior circulation large-vessel occlusion and was established as the new standard of care in recent years (1–3). Nonetheless, there is still a significant proportion of patients who fail to achieve favorable outcomes, and 28.6–67.8% of patients have poor functional outcomes after MT therapy (4). Previous studies have found several factors that could potentially affect the prognosis after mechanical thrombectomy (5), including early neurological deterioration (END) (6, 7).

END is common in acute ischemic stroke, occurs in 10–40% of patients (8), and is directly associated with poor long-term outcomes after stroke (5, 6, 9). Adjusted for factors such as age, sex, initial stroke severity, and admission time, END increases the risk of poor outcomes at 3 months by approximately 8–34 times and increases mortality by 5-fold (8, 10).

Therefore, early identification of high-risk individuals with possible END will be helpful for clinicians to judge the prognosis after MT and to select the most appropriate candidates for MT therapy. Early intervention of the risk factors of END could possibly reduce the risk of adverse prognosis and improve functional outcomes that make patients benefit more from MT.

Several studies on END among patients treated with MT have found some independent predictors of END, such as age, admission systolic blood pressure, successful recanalization, and occlusion site (6, 7, 11, 12). However, there is not yet a suitable tool for clinicians to predict the risk of END before surgery.

Our study aimed to develop and validate a nomogram based on multi-center real-world data from Chinese patients to predict the risk of END after thrombectomy (direct or bridging thrombectomy) in AIS patients with anterior circulation large-vessel occlusion.