- 1Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- 2Department of Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China
- 3Department of Ultrasound, The Affiliated Zhangjiagang Hospital of Soochow University, Suzhou, China
Background: 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.
Methods: 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 (n = 142) and validation cohort (n = 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).
Results: 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.
Conclusion: A nomogram depended on CDU and
clinical features could accurately predict(Then what is the prediction protocol? Didn’t create one? You’re fucking useless!) recanalization in EICAD
patients. The nomogram may facilitate early identification of high-risk
patients and personalized therapeutic strategies.
Introduction
Extracranial internal carotid artery dissection (EICAD)
is a disorder characterized by the passage of blood via a rip in the
arterial wall layers, resulting in the blood entering the space between
these layers, causing the carotid wall to separate into two layers and
interfering with blood flow, which can lead to secondary stenosis or
aneurysmal dilatation (1).
Carotid artery dissection (CAD) accounts for around 25% of strokes in
young individuals, making it a significant factor in stroke occurrence
among individuals in their youth and middle age (2).
Therefore, the accurate diagnosis and effective treatment of carotid
artery dissection, as well as the enhancement of patients’ prognosis,
are of crucial in clinical practice. Digital subtraction angiography
(DSA) has traditionally been considered the most reliable method for
diagnosing EICAD. However, this technique is an invasive examination and
cannot clearly show the morphology of arterial wall, so it has certain
limitations in the clinical diagnosis and treatment process (3).
In recent times, high-resolution magnetic resonance imaging (HRMRI) has
been increasingly employed in clinical practice. It has a high
detection rate for intramural hematoma and can clearly show the
structure of the vessel wall. However, it is time-consuming (4).
Carotid Doppler ultrasound (CDU) has emerged as a valuable diagnostic
modality for the evaluation of EICAD. It offers several advantages over
other imaging techniques, such as being non-invasive and cost-effective,
and it can observe the lumen and artery wall of the extracranial
internal carotid artery in real-time. Therefore, CDU is of great value
in evaluating the variations in vascular wall structure of EICAD
patients.
Previous studies have been conducted on the recanalization rate of CAD (5–7),
while limited attention has been given to the influence factors of
recanalization. Furthermore, the nomogram is progressively employed as a
visual aid for the purpose of illness prevention. However, few studies
have combined CDU characteristics and clinical factors to establish a
nomogram to evaluate the recanalization of EICAD. We aim to combine CDU
features and clinical factors to identify those factors that are
significantly correlated to vessel recanalization and to establish a
nomogram to forecast the recanalization probability.
More at link.
