Department of Epidemiology and Biostatistics, Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University School of Public Health, Beijing, China.
Evidence-based Medicine Center, Xuanwu Hospital Capital Medical University, Beijing, China.
J Neurointerv Surg. 2023 Sep;15(e1):e41-e45. doi: 10.1136/neurintsurg-2022-019091. Epub 2022 Jul 27.
To propose a nomogram for individual risk assessment of in-stent restenosis (ISR) after vertebral artery origin stenosis (VAOS) stenting.
We included 793 patients with VAOS treated with stenting from October 2006 to May 2013, with a median follow-up of 27.8 months. Cox regression and the least absolute shrinkage and selection operator (LASSO) regression were adopted for variable selection. The nomogram was formulated and validated by concordance indexes (C-indexes) and calibration curves. An in-stent restenosis risk table (ISR-RT) was subsequently generated for risk stratification. Differences between low-, intermediate-, and high-risk levels were shown by Kaplan-Meier curves and compared by log-rank test.
The training and validation set included 594 and 199 patients, with a mean ISR rate of 37.2% and 35.2%, respectively. Stent type (HR=1.64, 95% CI 1.26 to 2.14), stent diameter (HR=2.48, 95% CI 1.77 to 3.48), history of peripheral vascular disease (HR=2.17, 95% CI 1.17 to 4.00), history of transit ischemic attack (HR=1.45, 95% CI 1.05 to 2.14), and left-side involvement (HR=1.33, 95% CI 1.04 to 1.69) were included in the nomogram. The C-indexes at 6 and 12 months were 0.650 and 0.611 in the training set, and 0.713 and 0.603 in the validation set, respectively. Compared with low-risk patients, the intermediate- and high-level group had 1.46 (95% CI 1.05 to 2.04; p=0.0235) and 2.28 (95% CI 1.64 to 3.17; p<0.0001) higher chances of developing ISR in 2 years, respectively.
A nomogram and a risk evaluation table were developed with good predictive ability for in-stent restenosis among patients with VAOS, which could serve as a practical approach for individualized risk evaluation.
提出一种用于评估椎动脉起始部狭窄（VAOS）支架置入后支架内再狭窄（ISR）个体风险的列线图。
我们纳入了 2006 年 10 月至 2013 年 5 月期间接受支架置入治疗的 793 例 VAOS 患者，中位随访时间为 27.8 个月。采用 Cox 回归和最小绝对收缩和选择算子（LASSO）回归进行变量选择。通过一致性指数（C 指数）和校准曲线来构建和验证列线图。随后生成了支架内再狭窄风险表（ISR-RT）进行风险分层。通过 Kaplan-Meier 曲线显示低、中、高危水平之间的差异，并通过对数秩检验进行比较。
训练集和验证集分别纳入了 594 例和 199 例患者，ISR 发生率分别为 37.2%和 35.2%。支架类型（HR=1.64，95%CI 1.26 至 2.14）、支架直径（HR=2.48，95%CI 1.77 至 3.48）、外周血管疾病史（HR=2.17，95%CI 1.17 至 4.00）、短暂性脑缺血发作史（HR=1.45，95%CI 1.05 至 2.14）和左侧受累（HR=1.33，95%CI 1.04 至 1.69）被纳入列线图。训练集的 6 个月和 12 个月 C 指数分别为 0.650 和 0.611，验证集的 C 指数分别为 0.713 和 0.603。与低危患者相比，中危和高危组在 2 年内发生 ISR 的几率分别为 1.46（95%CI 1.05 至 2.04；p=0.0235）和 2.28（95%CI 1.64 至 3.17；p<0.0001）。
本研究构建了一种预测 VAOS 支架置入后 ISR 发生风险的列线图和风险评估表，具有良好的预测能力，可作为个体化风险评估的实用方法。
