A Nomogram Model to Predict Malignant Cerebral Edema in Ischemic Stroke Patients Treated with Endovascular Thrombectomy: An Observational Study

Abstract

Mingyang Du,1,2,* Xianjun Huang,3,4,* Shun Li,2 Lili Xu,2 Bin Yan,1 Yi Zhang,4 Huaiming Wang,1,5,6 Xinfeng Liu1,4 1Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing 210002, Jiangsu Province, People’s Republic of China; 2Department of Cerebrovascular Disease Treatment Center, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing 210002, Jiangsu Province, People’s Republic of China; 3Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, People’s Republic of China; 4Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing 210002, Jiangsu Province, People’s Republic of China; 5Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, People’s Republic of China; 6Department of Neurology, The 80th Group Army Hospital of People’s Liberation Army, Weifang, Shandong Province, People’s Republic of China*These authors contributed equally to this workCorrespondence:Xinfeng LiuDepartment of Neurology, Jinling Clinical College of Nanjing Medical University, 305# East Zhongshan Road, Nanjing 210002, Jiangsu, People’s Republic of ChinaTel [phone]Fax [phone]Email [email protected] WangDepartment of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, People’s Republic of ChinaTel [phone]Fax [phone]Email [email protected]: Malignant cerebral edema (MCE) in patients undergoing endovascular thrombectomy (EVT) is not uncommon and can reduce the benefit of EVT. We aimed to develop a nomogram model to predict the risk of MCE in ischemic stroke patients after EVT.Patients and Methods: We retrospectively collected patients treated with EVT caused by anterior circulation large vessel occlusion stroke at two comprehensive stroke centers. MCE was defined as midline shift > 5 mm at the septum pellucidum or pineal gland with obliteration of the basal cisterns or the need for early decompressive hemicraniectomy. A multivariate logistic model was utilized to construct the best-fit nomogram model. The discrimination and calibration of the nomogram were estimated using the area under the receiver operating characteristic curve (AUC-ROC) and Hosmer–Lemeshow test.Results: A total of 370 patients (mean age, 67.2± 11.9 years; male, 56.8%) were enrolled in the final analysis. Among them, 71 (19.2%) patients experienced MCE after EVT treatment. After adjustment for potential confounders, age, baseline National Institutes of Health Stroke Scale score, collateral circulation, fast blood glucose level and recanalization were independent predictors of MCE and were incorporated into the nomogram. The AUC-ROC value of the nomogram was 0.805 (95% confidence interval [CI]: 0.750– 0.860). The Hosmer–Lemeshow goodness-of-fit test showed good calibration of the nomogram (P = 0.681).Conclusion: The nomogram composed of age, baseline National Institutes of Health Stroke Scale score, blood glucose level, collateral circulation and recanalization may predict the probability of MCE in anterior circulation large vessel occlusion stroke patients treated with EVT.Keywords: endovascular thrombectomy, edema, nomogram, stroke

Keywords

• endovascular thrombectomy
• edema
• nomogram
• stroke