Predicting vessel recanalization in extracranial internal carotid artery dissection: a nomogram based on ultrasonography and clinical features

 Collaterals grew around my blocked right carotid artery 13 years post stroke. Now 6 years later I still haven't had another stroke. This research told me nothing, what is the objective identification of a high risk patient? I'd have everyone fired!

Predicting vessel recanalization in extracranial internal carotid artery dissection: a nomogram based on ultrasonography and clinical features

Xinchun Xu^1,2,3Yanhong Yan^1,2Yafeng Qu³Lianlian Zhang^1,2Pinjing Hui^1,2*

• ¹Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
• ²Department of Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China
• ³Department of Ultrasound, The Affiliated Zhangjiagang Hospital of Soochow University, Suzhou, China

Background: Extracranial internal carotid artery dissection (EICAD) is a prominent factor in ischemic stroke in young patients, and vessel recanalization is correlated with stroke recurrence. We propose to determine the possible association between carotid duplex ultrasound (CDU) features, clinical factors, and vessel recanalization in EICAD patients.

Methods: In the current retrospective study, data from 202 patients diagnosed with EICAD by CDU and confirmed by computed tomography angiography (CTA) or high-resolution magnetic resonance imaging (HRMRI) were encompassed. Patients were randomized 7:3 into training cohort (n = 142) and validation cohort (n = 60). The least absolute shrinkage and selection operator (LASSO) regression analysis and multivariate logistic regression analysis were used to build a nomogram to predict recanalization. At last, we assessed the performance of the nomogram with an area under the receiver operating characteristic curve (AUC), calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC).

Results: The nomogram included CDU features (intramural hematoma, Intraluminal thrombus, and stenosis degree) and age, with AUC values of 0.906 (95% CI: 0.857–0.946) and 0.903 (95% CI: 0.820–0.963) in the training cohort and the validation cohort, respectively. Using a probability cutoff of 0.5 derived from the Youden index, patients were stratified into high-risk (recanalization probability <50%) and low-risk groups (≥50%). DCA showed that the nomogram performed significantly better across various threshold probabilities, and CIC demonstrated that the nomogram offers superior net benefit across a broad range of threshold probabilities, indicating its significant predictive value.

Conclusion: A nomogram depended on CDU and clinical features could accurately predict(Then what is the prediction protocol? Didn't create one? You're fucking useless!) recanalization in EICAD patients. The nomogram may facilitate early identification of high-risk patients and personalized therapeutic strategies.

Introduction

Extracranial internal carotid artery dissection (EICAD) is a disorder characterized by the passage of blood via a rip in the arterial wall layers, resulting in the blood entering the space between these layers, causing the carotid wall to separate into two layers and interfering with blood flow, which can lead to secondary stenosis or aneurysmal dilatation (1). Carotid artery dissection (CAD) accounts for around 25% of strokes in young individuals, making it a significant factor in stroke occurrence among individuals in their youth and middle age (2). Therefore, the accurate diagnosis and effective treatment of carotid artery dissection, as well as the enhancement of patients’ prognosis, are of crucial in clinical practice. Digital subtraction angiography (DSA) has traditionally been considered the most reliable method for diagnosing EICAD. However, this technique is an invasive examination and cannot clearly show the morphology of arterial wall, so it has certain limitations in the clinical diagnosis and treatment process (3). In recent times, high-resolution magnetic resonance imaging (HRMRI) has been increasingly employed in clinical practice. It has a high detection rate for intramural hematoma and can clearly show the structure of the vessel wall. However, it is time-consuming (4). Carotid Doppler ultrasound (CDU) has emerged as a valuable diagnostic modality for the evaluation of EICAD. It offers several advantages over other imaging techniques, such as being non-invasive and cost-effective, and it can observe the lumen and artery wall of the extracranial internal carotid artery in real-time. Therefore, CDU is of great value in evaluating the variations in vascular wall structure of EICAD patients.

Previous studies have been conducted on the recanalization rate of CAD (5–7), while limited attention has been given to the influence factors of recanalization. Furthermore, the nomogram is progressively employed as a visual aid for the purpose of illness prevention. However, few studies have combined CDU characteristics and clinical factors to establish a nomogram to evaluate the recanalization of EICAD. We aim to combine CDU features and clinical factors to identify those factors that are significantly correlated to vessel recanalization and to establish a nomogram to forecast the recanalization probability.

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