A Nomogram for Predicting Symptomatic Intracranial Hemorrhage after Endovascular Thrombectomy

Kang, Zhiming; Nie, Chuang; Ouyang, Keni; Wu, Xinwei; Yin, Jiaqi; Sun, Dong; Mei, Bin

doi:10.1016/j.clineuro.2022.107298

Cited by 5 publications

(4 citation statements)

References 25 publications

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“…This disparity in ASPECTS may account for the increased frequency of hemorrhagic transformation in patients with positive proximal HMCAS [14]. Previous studies have consistently demonstrated that HMCAS is correlated with larger cerebral infarct volumes, measured using the "one-third middle cerebral artery area" principle or ASPECTS on initial NCCT scans [5,[15][16][17], which is a well-established risk factor for HT following MT [18][19][20].…”

Section: Discussionmentioning

confidence: 99%

The prognostic significance of hyperdense middle cerebral artery sign in cardioembolic stroke patients undergoing mechanical thrombectomy:a multicenter observational clinical study

Liu,

Zhang,

Luo

et al. 2024

Preprint

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Objective: This study aimed to investigate the association between the presence of the hyperdense middle cerebral artery sign (HMCAS) on pre-treatment non-contrast CT (NCCT) scans and the subsequent occurrence of poor functional outcomes and hemorrhagic transformation (HT) in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO) attributed to cardioembolic etiology, following mechanical thrombectomy (MT). Methods: We conducted a retrospective analysis using patient data from the multicenter clinical trial known as MONFIS-ET, focusing on individuals with cardioembolic (CE) and large-artery atherosclerotic (LAA) occlusive strokes. Patients were categorized into four groups based on the presence of HMCAS and the underlying stroke etiology. We compared the 90-day modified Rankin score (mRS) and the incidence of HT between those with HMCAS and those without it, stratified by etiology. Results: A total of 269 patients were included in the study, of which 85 (31.6%) exhibited HMCAS on NCCT scans. Patients without HMCAS demonstrated more favorable clinical outcomes compared to those with HMCAS (56.0% vs. 41.2%, p=0.024). Specifically, patients with HMCAS associated with cardioembolism (CE) had a less favorable outcome (20% vs. 46.7%, p=0.013) and a higher incidence of HT (65.7% vs. 33.3%, p=0.004). Conversely, there was no significant difference in prognosis between patients with HMCAS and those without it in the context of large artery atherosclerosis (58.2% vs. 57.7%, p=0.959). In multivariate logistic regression analysis, the HMCAS independently predicted poor prognosis in patients who underwent MT due to CE (OR: 4.054, 95% CI: 1.161-14.159, p=0.028). Conclusion: In patients with AIS-LVO attributed to cardioembolic etiology who underwent MT, the presence of HMCAS on initial NCCT scans was found to be associated with an unfavorable outcome and a higher incidence of HT. Clinical Trial Registration: ChiCTR 2300074368(retrospectively registered).

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Section: Discussionmentioning

confidence: 99%

The prognostic significance of hyperdense middle cerebral artery sign in cardioembolic stroke patients undergoing mechanical thrombectomy:a multicenter observational clinical study

Liu,

Zhang,

Luo

et al. 2024

Preprint

View full text Add to dashboard Cite

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“…In addition, another two studies focusing on the prognostic value of HMCAS on treatment outcomes of EVT found that patients with HMCAS had a higher rate of sHT after the EVT despite statistical insignificance [19,20]. Previous studies have demonstrated that HMCAS on initial NCCT was associated with larger cerebral infarction volume measured by the "one-third of the MCA territory" principle or ASPECTS [12][13][14][15], which is established risk factor of HT after EVT [5,9,10]. In our study, patients with proximal HMCAS had lower ASPECTS on initial NCCT than those with negative HMCAS and proximal MCA occlusion, and proximal HMCAS was independently associated with an increased risk of HT and aHT in multivariate logistic regression analyses.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have validated certain risk factors of HT after EVT, such as the National Institutes of Health Stroke Scale (NIHSS) score, hyperglycemia on admission, Alberta Stroke Program Early CT Score (ASPECTS) and unsuccessful recanalization [ 4 , 5 , 9 , 10 ]. However, an easy-to-use imaging marker for routine practice has not been identified.…”

Section: Introductionmentioning

confidence: 99%

Proximal hyperdense middle cerebral artery sign is associated with increased risk of asymptomatic hemorrhagic transformation after endovascular thrombectomy: a multicenter retrospective study

Kang

Sun

et al. 2022

J Neurol

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Objective To investigate whether hyperdense middle cerebral artery sign (HMCAS) on pretreatment no-contrast CT (NCCT) is associated with hemorrhagic transformation (HT) after endovascular thrombectomy (EVT). Methods Patients with acute middle cerebral artery (MCA) occlusion who received EVT in three comprehensive hospitals were retrospectively evaluated. They were divided into four groups based on the presence or absence of HMCAS and corresponding CTA findings, among whom differences were compared. Univariate and multivariate logistic regression analyses were performed to investigate the association between HMCAS and HT and its subtypes. Results 318 patients were included, among whom 149 (46.9%) had HMCAS. Patients in the proximal positive HMCAS group had higher National Institute of Health Stroke Scale scores and lower Alberta Stroke Program Early CT Scores (ASPECTS) than those in the proximal negative HMCAS group. The rate of HT was higher in the proximal positive HMCAS group than that in the proximal negative HMCAS group. In multivariate logistic regression analysis, the proximal HMCAS were independently associated with HT (adjusted OR = 2.073, 95% CI 1.211–3.551, p = 0.008) and aHT (adjusted OR = 2.271, 95% CI 1.294–3.986, p = 0.004), but not with sHT. Patients who developed HT, including aHT and sHT, had a lower rate of good outcome. Conclusion Proximal HMCAS on initial NCCT was independently associated with aHT in patients who received EVT for acute MCA occlusion. Both aHT and sHT had a detrimental effect on clinical outcome.

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“…The bootstrap resampling (1000 times) was performed to internally verify the predictive accuracy of the nomogram 20 . R Software Version 4.2.1 was utilized to perform statistical analyses.…”

Section: Methodsmentioning

confidence: 99%

Analysis of prognostic factors and establishment of prognostic model for primary mediastinal germ cell tumors: a case controlled study

Leng

Cui

Mai

et al. 2023

International Journal of Surgery

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Background: The overall prognosis of primary mediastinal germ cell tumors (PMGCTs) is poor and the associated prognostic factors are not fully understood. Our goal was to investigate the prognostic factors of PMGCTs and to develop a validated prognostic prediction model. Materials and Methods: A total of 114 PMGCTs with specific pathological types were included in this study. Clinicopathological characteristics of nonseminomatous PMGCTs and mediastinal seminomas were compared using the χ 2 or Fisher’s exact test. Independent prognostic factors of nonseminomatous PMGCTs screened using the univariate and multivariate Cox regression analysis were then used to generate a nomogram. The predictive performance of the nomogram was evaluated using the concordance index, decision curve, and the area under the receiver operating characteristic curve (AUC) and validated by bootstrap resampling. The Kaplan–Meier curves of independent prognostic factors were analyzed. Results: This study included 71 cases of nonseminomatous PMGCTs and 43 cases of mediastinal seminomas. The 3-year overall survival rates for nonseminomatous PMGCTs and mediastinal seminomas patients were 54.5 and 97.4%, respectively. The overall survival prognostic nomogram for nonseminomatous PMGCTs was established by integrating independent prognostic factors, including the Moran-Suster stage, white blood cell, hemoglobin, and platelet-lymphocyte ratio. The nomogram demonstrated good performance with a concordance index of 0.760 and the 1-year and 3-year AUC values of 0.821 and 0.833, respectively. These values were better than those of the Moran-Suster stage system. The bootstrap validation had an AUC of 0.820 (0.724–0.915) and showed a well-fitting calibration curve. Besides, patients with mediastinal seminomas showed favorable clinical outcomes and all the nine patients received neoadjuvant therapy and postoperative surgery achieved pathological complete response. Conclusion: A nomogram based on staging and blood routine examination results was established to accurately and consistently predict the prognosis of patients with nonseminomatous PMGCTs.

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A Nomogram for Predicting Symptomatic Intracranial Hemorrhage after Endovascular Thrombectomy

Cited by 5 publications

References 25 publications

The prognostic significance of hyperdense middle cerebral artery sign in cardioembolic stroke patients undergoing mechanical thrombectomy:a multicenter observational clinical study

The prognostic significance of hyperdense middle cerebral artery sign in cardioembolic stroke patients undergoing mechanical thrombectomy:a multicenter observational clinical study

Proximal hyperdense middle cerebral artery sign is associated with increased risk of asymptomatic hemorrhagic transformation after endovascular thrombectomy: a multicenter retrospective study

Analysis of prognostic factors and establishment of prognostic model for primary mediastinal germ cell tumors: a case controlled study

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