A Nomogram Model to Predict Malignant Cerebral Edema in Ischemic Stroke Patients Treated with Endovascular Thrombectomy: An Observational Study
Open Access
- 1 January 2020
- journal article
- research article
- Published by Taylor & Francis Ltd in Neuropsychiatric Disease and Treatment
- Vol. 16, 2913-2920
- https://doi.org/10.2147/NDT.S279303
Abstract
Purpose: 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.This publication has 33 references indexed in Scilit:
- Brain Edema Predicts Outcome After Nonlacunar Ischemic StrokeStroke, 2014
- The DASH score: A simple score to assess risk for development of malignant middle cerebral artery infarctionJournal of the Neurological Sciences, 2014
- Cerebral Edema in Acute Ischemic Stroke Patients Treated with Intravenous ThrombolysisInternational Journal of Stroke, 2012
- The Severity of Ischemia Determines and Predicts Malignant Brain Edema in Patients with Large Middle Cerebral Artery InfarctionCerebrovascular Diseases, 2011
- Prediction of malignant middle cerebral artery infarction by magnetic resonance imaging within 6 hours of symptom onset: A prospective multicenter observational studyAnnals of Neurology, 2010
- Malignant middle cerebral artery infarction: clinical characteristics, treatment strategies, and future perspectivesThe Lancet Neurology, 2009
- Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trialsThe Lancet Neurology, 2007
- The Prediction of Malignant Cerebral Infarction by Molecular Brain Barrier Disruption MarkersStroke, 2005
- Late secondary ischemic injury in patients receiving intraarterial thrombolysisAnnals of Neurology, 2002
- Secondary decline in apparent diffusion coefficient and neurological outcomes after a short period of focal brain ischemia in ratsAnnals of Neurology, 2000