He Yuxuan, Zuo Meng, Huang Jialu, Jiang Ying, Zhou Linke, Li Guangjian, Chen Lin, Liu Qu, Liang Dingwen, Wang Yu, Wang Li, Zhou Zhenhua
Department of Neurology, School of Medicine, Chongqing University, Chongqing, China; Department of Neurology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
Department of Neurology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
World Neurosurg. 2023 May;173:e548-e558. doi: 10.1016/j.wneu.2023.02.091. Epub 2023 Feb 25.
Malignant cerebral edema (MCE) is a common and feared complication after endovascular thrombectomy (EVT) in acute ischemic stroke (AIS). This study aimed to establish a nomogram to predict MCE in anterior circulation large vessel occlusion stroke (LVOS) patients receiving EVT in order to guide the postoperative medical care in the acute phase.
In this retrospective cohort study, 381 patients with anterior circulation LVOS receiving EVT were screened from 636 hospitalized patients with LVOS at 2 stroke medical centers. Clinical baseline data and imaging data were collected within 2-5 days of admission to the hospital. The patients were divided into 2 groups based on whether MCE occurred after EVT. Multivariate logistic regression analysis was used to evaluate the independent risk factors for MCE and to establish a nomogram.
Sixty-six patients out of 381 (17.32%) developed MCE. The independent risk factors for MCE included admission National Institutes of Health Stroke Scale (NIHSS) ≥16 (odds ratio [OR] 1.851; 95% CI 1.029-3.329; P = 0.038), ASPECT score (OR 0.621; 95% CI 0.519-0.744; P < 0.001), right hemisphere (OR 1.636; 95% CI 0.941-2.843; P = 0.079), collateral circulation (OR 0.155; 95% CI 0.074-0.324; P < 0.001), recanalization (OR 0.223; 95% CI 0.109-0.457; P < 0.001), hematocrit (OR, 0.937; 95% CI: 0.892-0.985; P =0.010), and glucose (OR 1.118; 95% CI 1.023-1.223; P = 0.036), which were adopted as parameters of the nomogram. The receiver operating characteristic curve analysis showed that the area under the curve of the nomogram in predicting MCE was 0.901(95% CI 0.848-0.940; P < 0.001). The Hosmer-Lemeshow test results were not significant (P = 0.685), demonstrating a good calibration of the nomogram.
The novel nomogram composed of admission NIHSS, ASPECT scores, right hemisphere, collateral circulation, recanalization, hematocrit, and serum glucose provide a potential predictor for MCE in patients with AIS after EVT.
恶性脑水肿（MCE）是急性缺血性卒中（AIS）血管内血栓切除术（EVT）后常见且可怕的并发症。本研究旨在建立一种列线图，以预测接受EVT的前循环大血管闭塞性卒中（LVOS）患者发生MCE的情况，从而指导急性期的术后医疗护理。
在这项回顾性队列研究中，从2个卒中医疗中心的636例住院LVOS患者中筛选出381例接受EVT的前循环LVOS患者。在入院后2 - 5天内收集临床基线数据和影像数据。根据EVT后是否发生MCE将患者分为2组。采用多因素逻辑回归分析评估MCE的独立危险因素并建立列线图。
381例患者中有66例（17.32%）发生MCE。MCE的独立危险因素包括入院时美国国立卫生研究院卒中量表（NIHSS）≥16（比值比[OR]1.851；95%置信区间1.029 - 3.329；P = 0.038）, ASPECT评分（OR 0.621；95%置信区间0.519 - 0.744；P < 0.001），右侧半球（OR 1.ó36；95%置信区间0.941 - 2.843；P = 0.079）, 侧支循环（OR 0.155；95%置信区间0.074 - 0.324；P < 0.001）, 再通（OR 0.223；95%置信区间0.109 - 0.457；P < 0.001）, 血细胞比容（OR 0.ù37；95%置信区间：0.892 - 0.985；P = 0.010）, 以及血糖（OR 1.118；95%置信区间1.023 - 1.223；P = 0.036），这些因素被用作列线图的参数。受试者工作特征曲线分析显示，列线图预测MCE的曲线下面积为0.901（95%置信区间0.848 - 0.940；P < 0.001）。Hosmer - Lemeshow检验结果无统计学意义（P = 0.685），表明列线图具有良好的校准度。
由入院时NIHSS、ASPECT评分、右侧半球、侧支循环、再通、血细胞比容和血清葡萄糖组成的新型列线图为AIS患者EVT术后发生MCE提供了一个潜在的预测指标。
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