Xu Xinchun, Yan Yanhong, Qu Yafeng, Zhang Lianlian, Hui Pinjing
Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China.
Front Neurol. 2025 Apr 7;16:1498182. doi: 10.3389/fneur.2025.1498182. eCollection 2025.
Extracranial internal carotid artery dissection (EICAD) is a prominent factor in ischemic stroke in young patients, and vessel recanalization is correlated with stroke recurrence. We propose to determine the possible association between carotid duplex ultrasound (CDU) features, clinical factors, and vessel recanalization in EICAD patients.
In the current retrospective study, data from 202 patients diagnosed with EICAD by CDU and confirmed by computed tomography angiography (CTA) or high-resolution magnetic resonance imaging (HRMRI) were encompassed. Patients were randomized 7:3 into training cohort ( = 142) and validation cohort ( = 60). The least absolute shrinkage and selection operator (LASSO) regression analysis and multivariate logistic regression analysis were used to build a nomogram to predict recanalization. At last, we assessed the performance of the nomogram with an area under the receiver operating characteristic curve (AUC), calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC).
The nomogram included CDU features (intramural hematoma, Intraluminal thrombus, and stenosis degree) and age, with AUC values of 0.906 (95% CI: 0.857-0.946) and 0.903 (95% CI: 0.820-0.963) in the training cohort and the validation cohort, respectively. Using a probability cutoff of 0.5 derived from the Youden index, patients were stratified into high-risk (recanalization probability <50%) and low-risk groups (≥50%). DCA showed that the nomogram performed significantly better across various threshold probabilities, and CIC demonstrated that the nomogram offers superior net benefit across a broad range of threshold probabilities, indicating its significant predictive value.
A nomogram depended on CDU and clinical features could accurately predict recanalization in EICAD patients. The nomogram may facilitate early identification of high-risk patients and personalized therapeutic strategies.
颅外颈内动脉夹层（EICAD）是年轻患者缺血性卒中的一个重要因素，血管再通与卒中复发相关。我们旨在确定EICAD患者的颈动脉双功超声（CDU）特征、临床因素与血管再通之间可能存在的关联。
在当前这项回顾性研究中，纳入了202例经CDU诊断并经计算机断层血管造影（CTA）或高分辨率磁共振成像（HRMRI）确诊为EICAD的患者的数据。患者按7:3随机分为训练队列（n = 142）和验证队列（n = 60）。采用最小绝对收缩和选择算子（LASSO）回归分析及多因素逻辑回归分析构建预测再通的列线图。最后，我们用受试者操作特征曲线下面积（AUC）、校准曲线、决策曲线分析（DCA）和临床影响曲线（CIC）评估列线图的性能。
该列线图纳入了CDU特征（壁内血肿、管腔内血栓和狭窄程度）及年龄，训练队列和验证队列的AUC值分别为0.906（95%CI：0.857 - 0.946）和0.903（95%CI：0.820 - 0.963）。采用约登指数得出的概率截断值0.5，将患者分为高风险组（再通概率<50%）和低风险组（≥50%）。DCA显示，列线图在各种阈值概率下的表现均显著更好，CIC表明列线图在广泛的阈值概率范围内提供了更高的净效益，表明其具有显著的预测价值。
基于CDU和临床特征的列线图能够准确预测EICAD患者的再通情况。该列线图可能有助于早期识别高风险患者并制定个性化治疗策略。
