Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China.
Department of Neurosurgery, Binhai People's Hospital, Jiangsu Province, China.
Oxid Med Cell Longev. 2020 Dec 17;2020:8823283. doi: 10.1155/2020/8823283. eCollection 2020.
An easy scoring system to predict the risk of poor outcome after mechanical thrombectomy among the elderly is currently not available. Therefore, we aimed to develop a nomogram for predicting the probability of negative prognosis in aged patients with acute ischemic stroke undergoing thrombectomy. In addition, we sought to investigate the association between histological thrombus composition and stroke characteristics. To this end, we prospectively studied a developed cohort using data collected from a stroke center from November 2015 to December 2019. The main outcome was functional independence, defined as a modified Rankin Scale score ≤ 2 at 90 days following a mechanical thrombectomy. A nomogram model based on multivariate logistic models was generated. The retrieved thrombi were stained with hematoxylin and eosin and assessed according to histological composition. Our results demonstrated that age ≥ 72 years was independently associated with poor outcome. A total of 304 participants completed the follow-up data to generate the nomogram model. After multivariate logistic regression, five variables remained independent predictors of outcome, including older age, hemorrhagic transformation, thrombolysis in cerebral infarction score, National Institute of Health Stroke score, and neutrophil-to-lymphocyte ratio, and were used to generate the nomogram. The area under the receiver-operating characteristic curve of the model was 0.803. The clots from elderly subjects with large-artery atherosclerosis, anterior circulation, and successful recanalization groups had a higher percentage of fibrin compared to those of younger patients. This is the first nomogram to be developed and validated in a stroke center cohort for individualized prediction of poor outcome in elderly patients after mechanical thrombectomy. Clot composition provides valuable information on the underlying pathogenesis of oxidation in older patients.
目前尚无一种简单的评分系统可以预测老年患者接受机械取栓后预后不良的风险。因此，我们旨在开发一种列线图，以预测接受取栓的老年急性缺血性脑卒中患者发生不良预后的概率。此外，我们还研究了组织学血栓成分与卒中特征之间的关系。为此，我们前瞻性地研究了一个开发队列，该队列使用 2015 年 11 月至 2019 年 12 月期间从一个卒中中心收集的数据。主要结局是功能独立性，定义为机械取栓后 90 天改良 Rankin 量表评分≤2。基于多变量逻辑模型生成了列线图模型。所提取的血栓用苏木精和伊红染色，并根据组织学成分进行评估。结果表明，年龄≥72 岁与预后不良独立相关。共有 304 名参与者完成了随访数据以生成列线图模型。经过多变量逻辑回归，5 个变量仍然是结局的独立预测因素，包括年龄较大、出血性转化、脑梗死溶栓评分、国立卫生研究院卒中评分和中性粒细胞与淋巴细胞比值，并用于生成列线图。该模型的受试者工作特征曲线下面积为 0.803。大动脉粥样硬化、前循环和成功再通组的老年患者血栓中纤维蛋白的比例高于年轻患者。这是第一个在卒中中心队列中开发和验证的列线图，用于个体化预测老年患者机械取栓后预后不良。血栓成分提供了关于老年患者氧化潜在发病机制的有价值信息。
