ABSTRACT
Objective:To establish and verify a dynamic web-based nomogram for predicting futile recanalization after thrombectomy in acute ischemic stroke.Methods:Three hundred and four acute ischemic stroke patients admitted to the Second Affiliated Hospital of Soochow University from May 2017 to April 2021 were retrospectively enrolled. All these patients underwent mechanical thrombectomy and obtained successful recanalization. The eligible patients were randomly divided into training group ( n=216) and test group ( n=88) by 7∶3. The nomogram was established and internally validated with the data of the training group, and externally validated with the data of the test group. For the training group, multivariate Logistic regression analysis was performed by including all variables with P<0.05 in univariate analysis, and the independent predictors of futile recanalization were screened out to construct a nomogram. In the training group and the test group, the performance of the nomogram was verified by C-index, calibration chart and decision curve analysis respectively. Results:No significant difference was detected between the training group and the test group in futile recanalization [134/216 (62.0%) vs 56/88 (63.6%), χ 2=0.07, P=0.794]. Multivariate Logistic regression analysis showed that age ( OR=1.04,95% CI 1.00-1.08, P=0.033), National Institutes of Health Stroke Scale (NIHSS) score on admission ( OR=1.11,95% CI 1.04-1.19, P=0.001), neutrophil to lymphocyte ratio ( OR=1.19,95% CI 1.07-1.32, P=0.001), glycated hemoglobins ( OR=2.02,95% CI 1.34-3.05, P<0.001), poor collateral status ( OR=10.87,95% CI 4.08-29.01, P<0.001), postoperative high density ( OR=11.38,95% CI 4.56-28.40, P<0.001) were independent risk factors for futile recanalization. The C-index of this nomogram in the training group and the test group was 0.92 (95% CI 0.877-0.954, P<0.001) and 0.93 (95% CI 0.87-0.98, P<0.001), respectively. Conclusion:This web-based nomogram, including age, NIHSS score on admission, neutrophil to lymphocyte ratio, glycated hemoglobin, poor collateral status and postoperative high density, predicted individual probability of futile recanalization after mechanical thrombectomy with good discrimination and clinical utility.
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Objective To compare the cognitive function of patients with carotid stenosis combined with white matter lesions (WML)after carotid artery stenting (CAS). Methods Total 166 patients with carotid artery stenosis were collected.According to MRI imaging,30 patients with no white matter lesions were included in the control group and 136 patients with white matter lesions were included in the white matter lesions group. They were treated with carotid artery stenting and underwent evaluation on the safety and efficacy of perioperative surgery. CAS failed in two patients because of the inability of guidewire crossing in WML group. Two patients died after CAS (one for cardiac death and one for traumatic accident) in WML group. 162 patients received 1 year follow-up. Cognitive function was assessed before and after CAS. Results Before CAS,WML group's MMSE, digit span forward/backward test, verbal fluency test and MoCA scores (21.8±3.3、6.3±2.1、4.1±1.0、15.1±3.6、20.6±3.1) were lower compared with control (24.3±3.9、7.3±2.6、4.7±1.8、17.7±5.2、22.7±4.2) and ADAS-Cog score was higher compared with control ((15.1±3.3) vs.(12.7±3.3)), P=0.000、0.026、0.039、0.012、0.000、0.011.Three months after CAS,the MMSE,digit span forward test and MoCA scores (23.7±3.6,7.5± 2.4, 23.1±6.9) was higher significantly than those before treatment (21.8±4.3, 6.3±2.09, 20.6±4.13), P<0.05.And the scores of ADAS-Cog was lower((13.2±4.)vs.(15.1±4.3),P<0.05).The scores of digit span backward test in 6 months after treatment was significant higher than those before treatment (4.9 ±2.8,4.1 ±2.2,P<0.05). After 1 year of CAS, the improvement in scores of MMSE, digit span forward test, ADAS-Cog and MoCA in patients with carotid stenosis complicated with WML(3.5±1.3,1.6±0.6,-2.6±0.8,3.6±1.1)was higher significant than control(2.7±1.8, 1.2±0.8, -2.0± 1.3, 2.7 ±1.5),P<0.05. Conclusion CAS can improve cognitive function in Patients with carotid artery stenosis complicated with WML than those who without WML.
ABSTRACT
Objective To investigate the effect of cystatin C (CysC) concentration on outcome of intravenous thrombolysis in patients with acute ischemic stroke.Methods The consecutive patients with acute ischemic stroke who underwent intravenous thrombolysis were enrolled retrospectively.They were divided into a good outcome group (≤2) and a poor outcome group (＞2) according to the Rankin scale.They were also divided into a hemorrhagic transformation (HT) group and a non-HT group according to whether they had HT or not.Their demographic data and clinical data were compared.Results A total of 103 patients with acute ischemic stroke treated with intravenous thrombolysis were enrolled,44 in the good outcome group,59 in the poor outcome group; 23 in the TH group,and 80 in the non-HT group.The age (62.34 ± 13.41 years vs.68.09 ± 9.74 years; t-2.521,P =0.013),baseline CysC concentration (1.008±0.28 mg/L vs.1.27±0.86 mg/L; t=2.237,P=0.027),incidence of HT (14％ vs.34.9％; x2 =6.016,P =0.014) and National Institutes of Health Stroke Scale (NIHSS) score (10.39 ± 3.11 vs.18 ±2.65; t =13.35,P ＜0.001) in the good outcome group were significantly lower than those in the poor outcome group.Multivariate logistic regression analysis showed that there was no significant independent correlation between CysC and clinical outcome (odds ratio 1.783,95％ confidence interval 0.443-7.185 ; P =0.416).The baseline CysC concentration (1.41 ± 0.54 mg/L vs.0.96± 0.18 mg/L; t =3.941,P=0.001) and the NIHSS score (15.96 ± 3.7 vs.13.05 ±4.87; t =3.017,P =0.004) in the non-HT group were significantly lower than those in the HT group.Multivariate logistic regression analysis showed that the plasma CysC concentration ＞ 1.03 mg/L (odds ratio 9.050,95％ confidence interval 2.384-34.359; P =0.001) was an independent risk factor for HT.Conclusions The increased baseline plasma CysC concentration was associated with the occurrence of HT in patients with acute ischemic stroke after intravenous thrombolysis therapy,but it was not associated with the outcomes.