Do you not understand, prognosis is useless for stroke survivors? It does nothing to get them recovered. There are a lot of mentors and senior researchers that need to be re-educated on the purpose of stroke research. The only goal in stroke is 100% recovery; not biomarkers, prediction, prognosis or other useless shit!
Nomogram to predict prognosis in patients with posterior circulation acute ischemic stroke after mechanical thrombectomy
Jiayang Li
Jin Zhang- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
Purpose: This study aimed to investigate the risk factors of prognosis and hemorrhagic transformation after mechanical thrombectomy (MT) in patients with posterior circulation acute ischemic stroke (PC-AIS) caused by large vessel occlusion. We sought to develop a nomogram for predicting the risk of poor prognosis and symptomatic intracerebral hemorrhage (sICH) in patients with PC-AIS.
Methods: A retrospective analysis was conducted on 81 patients with PC-AIS who underwent MT treatment. We collected clinical information from the patients to assessed sICH and prognosis based on CT results and National Institutes of Health Stroke Scale (NIHSS) scores. Subsequently, they were followed up for 3 months, and their prognosis was assessed using the Modified Rankin Scale. We used the least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression to determine the factors affecting prognosis to construct a nomogram. The nomogram’s performance was assessed through receiver operating characteristic curves, calibration curves, decision curve analysis, and clinical impact curves.
Results: Among the 81 patients with PC-AIS, 33 had a good prognosis, 48 had a poor prognosis, 19 presented with sICH, and 62 did not present with sICH. The results of the LASSO regression indicated that variables, including HPT, baseline NIHSS score, peak SBP, SBP CV, SBP SD, peak SBP, DBP CV, HbA1c, and BG SD, were predictors of patient prognosis. Variables such as AF, peak SBP, and peak DBP predicted the risk of sICH. Multivariate logistic regression revealed that baseline NIHSS score (OR = 1.115, 95% CI 1.002–1.184), peak SBP (OR = 1.060, 95% CI 1.012–1.111), SBP CV (OR = 1.296, 95% CI 1.036–1.621) and HbA1c (OR = 3.139, 95% CI 1.491–6.609) were independent risk factors for prognosis. AF (OR = 6.823, 95% CI 1.606–28.993), peak SBP (OR = 1.058, 95% CI 1.013–1.105), and peak DBP (OR = 1.160, 95% CI 1.036–1.298) were associated with the risk of sICH. In the following step, nomograms were developed, demonstrating good discrimination, calibration, and clinical applicability.
Conclusion: We constructed nomograms to predict poor prognosis and risk of sICH in patients with PC-AIS undergoing MT. The model exhibited good discrimination, calibration, and clinical applicability.
1 Introduction
Acute ischemic stroke (AIS) is the leading cause of disability and mortality, posing a severe threat to human well-being (1). Research on the Chinese population reveals that, in 2020, there were 15.5 million cases of ischemic stroke among adults >40 years, with a prevalence rate of approximately 2.3/100 people (2). Over 30% of AIS cases result from large vessel occlusion (LVO) (3). LVO causes ischemia and hypoperfusion in the affected area, and timely restoration of perfusion to the ischemic area can maintain brain cell activity. Thrombolysis treatment by intravenous recombinant tissue plasminogen activator is accessible within a 4.5 h window from the onset of symptoms. However, it is not always feasible owing to missed time windows or contraindications. In recent years, mechanical thrombectomy (MT) development has provided new treatment options for patients with AIS. MT treatment is safe and effective for patients with anterior circulation AIS (AC-AIS), extending the treatment time to 6–24 h (4).
Compared with AC-AIS, posterior circulation AIS (PC-AIS) occurs in the vertebrobasilar system-supplied area, resulting in a worse prognosis (5). The early symptoms of PC-AIS are mild and unspecific, making identification challenging. Therefore, patients with PC-AIS have a lower rate of benefit from intravenous thrombolysis than those with anterior circulation AIS, with only 1/6 of patients benefiting from this treatment (6). It indicates that MT is an important treatment for patients with PC-AIS. However, the outcome of MT treatment in PC-AIS remains controversial, with significant differences observed in four randomized controlled trials (RCTs). In the BEST and BASIC studies, no significant difference was observed in prognostic outcomes between the MT and drug therapy alone groups.
In contrast, the BAOCHE and ATTENTION studies indicated a more favorable prognosis for patients who underwent MT treatment (7–10). Most patients with PC-AIS can achieve revascularization after MT treatment; however, only 38% experience a good prognosis (11). Therefore, exploring the factors influencing prognosis can help clinicians identify patients at high risk of poor prognosis and provide more timely interventions. There are fewer studies on the factors influencing the prognosis of PC-AIS patients undergoing MT treatment. A meta-analysis revealed that hypertension and diabetes were associated with poor prognosis (12). Gao et al.’s study identified baseline National Institutes of Health Stroke Scale (NIHSS) score, posterior circulation acute stroke prognosis early computed tomography (PC-ASPECT) score, and modified thrombolysis in cerebral infarction (mTICI) classification as independent risk factors affecting patients’ prognosis (13).
Notably, no study investigates the impact of post-operative medical management on the risk of patients’ prognosis, and predictive models for poor prognosis and sICH are yet to be constructed. This study addresses these gaps by investigating factors affecting the prognosis and sICH of patients with PC-AIS undergoing MT and constructs a nomogram applicable to clinical practice. We aimed to guide targeted clinical interventions to improve the management of patients with PC-AIS and enhance their post-treatment prognosis.
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