Li Tianhua, Yang Renjie, Wang Jie, Wang Tao, Liu Guangjie, Jin Jiaqi, Bai Xuesong, Xu Ran, Lu Taoyuan, Wang Yabing, Dmytriw Adam A, Yang Bin, Jiao Liqun
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Xicheng District.
China International Neuroscience Institute (China-INI).
Int J Surg. 2024 Dec 1;110(12):7889-7899. doi: 10.1097/JS9.0000000000001833.
Silent cerebral infarction (SCI) that manifests following carotid artery stenting (CAS) has been postulated to correlate with cognitive decline, the onset of dementia, and an increased risk of subsequent cerebrovascular events. This investigation aimed to thoroughly examine the potential anatomical predispositions that are linked to the occurrence of SCI post-CAS, and further develop a predictive nomogram that could accurately forecast the risk of SCI post-CAS.
The present investigation conducted a retrospective examination of datasets from 250 individuals presenting with carotid artery stenosis who had been subjected to CAS within a tertiary healthcare institution from June 2020 to November 2021. Stratified by the procedural date, participants were allocated into a training cohort and a validation cohort. A nomogram was constructed predicated on salient prognostic determinants discerned via a multivariate logistic regression analysis.
An aggregate of 184 patients were incorporated into the study, of which 60 (32.6%) manifested SCI, whereas 124 (67.4%) did not. Within the training cohort ( n =123), age (OR 1.08, 95% CI: 1.01-1.16; P =0.034), aortic arch type (Type III vs. I: OR 10.79, 95% CI: 2.12-54.81; P =0.005), aortic arch variant (OR 47.71, 95% CI: 6.05-376.09; P <0.001), common carotid artery (CCA) ostium lesions (OR 6.93, 95% CI: 1.49-32.32; P =0.014), and proximal tortuosity index (TI) (OR 1.01, 95% CI: 1.00-1.02; P =0.029) were demarcated as standalone risk predispositions for SCI subsequent to CAS. The concordance index (C-index) for the training cohort's nomogram stood at 0.89 (95% CI: 0.84-0.95). Moreover, the said nomogram exhibited commendable efficacy within the validation cohort (C-index=0.94) as well as the entire participant base (C-index=0.90). Furthermore, the decision curve analysis illustrated the exemplary clinical applicability of the nomogram.
The findings of this inquiry underscore that age, aortic arch type, aortic arch variant, CCA ostium lesions, and proximal TI serve as independent determinants linked with SCI post-CAS. The formulated nomogram, predicated on these risk factors, possesses robust prognostic significance, and might serve as a valuable adjunct to inform clinical decision-making.
颈动脉支架置入术（CAS）后出现的无症状性脑梗死（SCI）被认为与认知功能下降、痴呆症的发生以及随后脑血管事件风险增加相关。本研究旨在全面检查与CAS后SCI发生相关的潜在解剖学易患因素，并进一步开发一种预测列线图，以准确预测CAS后SCI的风险。
本研究对2020年6月至2021年11月在一家三级医疗机构接受CAS治疗的250例颈动脉狭窄患者的数据集进行回顾性分析。根据手术日期分层，将参与者分为训练队列和验证队列。基于多因素逻辑回归分析确定的显著预后决定因素构建列线图。
共有184例患者纳入研究，其中60例（32.6%）出现SCI，124例（67.4%）未出现。在训练队列（n = 123）中，年龄（OR 1.08，95%CI：1.01 - 1.16；P = 0.034）、主动脉弓类型（III型与I型：OR 10.79，95%CI：2.12 - 54.81；P = 0.005）、主动脉弓变异（OR 47.71，95%CI：6.05 - 376.09；P < 0.001）、颈总动脉（CCA）开口病变（OR 6.93，95%CI：1.49 - 32.32；P = 0.014）和近端迂曲指数（TI）（OR 1.01，95%CI：1.00 - 1.02；P = 0.029）被确定为CAS后SCI的独立风险易患因素。训练队列列线图的一致性指数（C指数）为0.89（95%CI：0.84 - 0.95）。此外，该列线图在验证队列（C指数 = 0.94）以及整个参与者群体（C指数 = 0.90）中均表现出良好的效果。此外，决策曲线分析表明了列线图具有出色的临床适用性。
本研究结果强调，年龄、主动脉弓类型、主动脉弓变异、CCA开口病变和近端TI是与CAS后SCI相关的独立决定因素。基于这些危险因素制定的列线图具有强大的预后意义，可能作为临床决策的有价值辅助工具。
