Technical Risk Stratification Nomogram Model for 90-Day Mortality Prediction in Patients With Acute Basilar Artery Occlusion Undergoing Endovascular Thrombectomy: A Multicenter Cohort Study

Overview

Journal J Am Heart Assoc

Specialty Cardiology & Vascular Diseases

Date 2024 Mar 12

PMID 38471827

Authors

Heng Ni

Linbo Zhao

Xinghua Ma

Penghua Lv

Yasuo Ding

Zhensheng Liu

Haibin Shi

Sheng Liu

Affiliations

Soon will be listed here.

Abstract

Background: This study aimed to establish and validate a nomogram model for predicting 90-day mortality in patients with acute basilar artery occlusion receiving endovascular thrombectomy.

Methods And Results: A total of 242 patients with basilar artery occlusion undergoing endovascular thrombectomy were enrolled in our study, in which 172 patients from 3 stroke centers were assigned to the training cohort, and 70 patients from another center were assigned to the validation cohort. Univariate and multivariate logistic regression analyses were adopted to screen prognostic predictors, and those with significance were subjected to establish a nomogram model in the training cohort. The discriminative accuracy, calibration, and clinical usefulness of the nomogram model was verified in the internal and external cohorts. Six variables, including age, baseline National Institutes of Health Stroke Scale score, Posterior Circulation-Alberta Stroke Program Early CT (Computed Tomography) score, Basilar Artery on Computed Tomography Angiography score, recanalization failure, and symptomatic intracranial hemorrhage, were identified as independent predictors of 90-day mortality of patients with basilar artery occlusion and were subjected to develop a nomogram model. The nomogram model exhibited good discrimination, calibration, and clinical usefulness in both the internal and the external cohorts. Additionally, patients were divided into low-, moderate-, and high-risk groups based on the risk-stratified nomogram model.

Conclusions: Our study proposed a novel nomogram model that could effectively predict 90-day mortality of patients with basilar artery occlusion after endovascular thrombectomy and stratify patients with high, moderate, or low risk, which has a potential to facilitate prognostic judgment and clinical management of stroke.

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References

Gattringer T, Posekany A, Niederkorn K, Knoflach M, Poltrum B, Mutzenbach S . Predicting Early Mortality of Acute Ischemic Stroke. Stroke. 2018; 50(2):349-356. DOI: 10.1161/STROKEAHA.118.022863. View

Kwak H, Park J . Mechanical Thrombectomy in Basilar Artery Occlusion: Clinical Outcomes Related to Posterior Circulation Collateral Score. Stroke. 2020; 51(7):2045-2050. DOI: 10.1161/STROKEAHA.120.029861. View

Gory B, Mazighi M, Labreuche J, Blanc R, Piotin M, Turjman F . Predictors for Mortality after Mechanical Thrombectomy of Acute Basilar Artery Occlusion. Cerebrovasc Dis. 2018; 45(1-2):61-67. DOI: 10.1159/000486690. View

ODonnell M, Fang J, DUva C, Saposnik G, Gould L, McGrath E . The PLAN score: a bedside prediction rule for death and severe disability following acute ischemic stroke. Arch Intern Med. 2012; 172(20):1548-56. DOI: 10.1001/2013.jamainternmed.30. View

Langezaal L, van der Hoeven E, MontAlverne F, de Carvalho J, Lima F, Dippel D . Endovascular Therapy for Stroke Due to Basilar-Artery Occlusion. N Engl J Med. 2021; 384(20):1910-1920. DOI: 10.1056/NEJMoa2030297. View

Abdalkader M, Finitsis S, Li C, Hu W, Liu X, Ji X . Endovascular versus Medical Management of Acute Basilar Artery Occlusion: A Systematic Review and Meta-Analysis of the Randomized Controlled Trials. J Stroke. 2023; 25(1):81-91. PMC: 9911851. DOI: 10.5853/jos.2022.03755. View

Puetz V, Khomenko A, Hill M, Dzialowski I, Michel P, Weimar C . Extent of hypoattenuation on CT angiography source images in basilar artery occlusion: prognostic value in the Basilar Artery International Cooperation Study. Stroke. 2011; 42(12):3454-9. DOI: 10.1161/STROKEAHA.111.622175. View

Song K, Li F, Shi M, Yue F, Li C, Qi S . Basilar artery on computed tomography angiography score and clinical outcomes in acute basilar artery occlusion. J Neurol. 2022; 269(7):3810-3820. DOI: 10.1007/s00415-022-11013-1. View

Taussky P, Agnoletto G, Grandhi R, Alexander M, Wong K, Albers G . Prediction of death after endovascular thrombectomy in the extended window: a secondary analysis of DEFUSE 3 ". J Neurointerv Surg. 2020; 13(9):805-808. PMC: 8093992. DOI: 10.1136/neurintsurg-2020-016548. View

10.

Puetz V, Sylaja P, Coutts S, Hill M, Dzialowski I, Mueller P . Extent of hypoattenuation on CT angiography source images predicts functional outcome in patients with basilar artery occlusion. Stroke. 2008; 39(9):2485-90. DOI: 10.1161/STROKEAHA.107.511162. View

11.

Hacke W, Kaste M, Fieschi C, von Kummer R, Davalos A, Meier D . Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet. 1998; 352(9136):1245-51. DOI: 10.1016/s0140-6736(98)08020-9. View

12.

Liu X, Dai Q, Ye R, Zi W, Liu Y, Wang H . Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion (BEST): an open-label, randomised controlled trial. Lancet Neurol. 2019; 19(2):115-122. DOI: 10.1016/S1474-4422(19)30395-3. View

13.

Saposnik G, Kapral M, Liu Y, Hall R, ODonnell M, Raptis S . IScore: a risk score to predict death early after hospitalization for an acute ischemic stroke. Circulation. 2011; 123(7):739-49. DOI: 10.1161/CIRCULATIONAHA.110.983353. View

14.

Baik S, Park H, Kim J, Jang C, Kim B, Kim D . Mechanical Thrombectomy in Subtypes of Basilar Artery Occlusion: Relationship to Recanalization Rate and Clinical Outcome. Radiology. 2019; 291(3):730-737. DOI: 10.1148/radiol.2019181924. View

15.

Abdul-Rahim A, Quinn T, Alder S, Clark A, Musgrave S, Langhorne P . Derivation and Validation of a Novel Prognostic Scale (Modified-Stroke Subtype, Oxfordshire Community Stroke Project Classification, Age, and Prestroke Modified Rankin) to Predict Early Mortality in Acute Stroke. Stroke. 2015; 47(1):74-9. DOI: 10.1161/STROKEAHA.115.009898. View

16.

Jovin T, Li C, Wu L, Wu C, Chen J, Jiang C . Trial of Thrombectomy 6 to 24 Hours after Stroke Due to Basilar-Artery Occlusion. N Engl J Med. 2022; 387(15):1373-1384. DOI: 10.1056/NEJMoa2207576. View

17.

Liu C, Huang J, Kong W, Chen L, Song J, Yang J . Development and validation of machine learning-based model for mortality prediction in patients with acute basilar artery occlusion receiving endovascular treatment: multicentric cohort analysis. J Neurointerv Surg. 2023; 16(1):53-60. DOI: 10.1136/jnis-2023-020080. View

18.

Alemseged F, Shah D, Diomedi M, Sallustio F, Bivard A, Sharma G . The Basilar Artery on Computed Tomography Angiography Prognostic Score for Basilar Artery Occlusion. Stroke. 2017; 48(3):631-637. DOI: 10.1161/STROKEAHA.116.015492. View

19.

Chen F, Bai X, Wang X, Zhang L, Wang F, Huang L . Impact of high-sensitivity troponin elevation and dynamic changes on 90-day mortality in patients with acute ischemic stroke after mechanical thrombectomy: results from an observational cohort. J Neurointerv Surg. 2023; 15(11):1142-1147. PMC: 10579475. DOI: 10.1136/jnis-2022-019682. View

20.

Tao C, Nogueira R, Zhu Y, Sun J, Han H, Yuan G . Trial of Endovascular Treatment of Acute Basilar-Artery Occlusion. N Engl J Med. 2022; 387(15):1361-1372. DOI: 10.1056/NEJMoa2206317. View