Nomogram to Predict the Number of Thrombectomy Device Passes for Acute Ischemic Stroke with Endovascular Thrombectomy

Shijie Yang; Kaixuan Zhao; Huan Xi; Zaixing Xiao; Wei Li; Yichuan Zhang; Zhiqiang Fan; Changqing Li; Erqing Chai

doi:10.2147/RMHP.S317834

Nomogram to Predict the Number of Thrombectomy Device Passes for Acute Ischemic Stroke with Endovascular Thrombectomy

Risk Manag Healthc Policy. 2021 Oct 29:14:4439-4446. doi: 10.2147/RMHP.S317834. eCollection 2021.

Authors

Shijie Yang¹, Kaixuan Zhao², Huan Xi¹, Zaixing Xiao¹, Wei Li¹, Yichuan Zhang², Zhiqiang Fan¹, Changqing Li^{3

4}, Erqing Chai^{3

4}

Affiliations

¹ The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Gansu University of Chinese Medicine, Lanzhou, Gansu, People's Republic of China.
² Clinical Medical College, Ningxia Medical University, Yinchuan, Ningxia, People's Republic of China.
³ Cerebrovascular Disease Center, Gansu Provincial Hospital, Lanzhou, Gansu, People's Republic of China.
⁴ Key Laboratory of Cerebrovascular Disease of Gansu Province, Gansu Provincial Hospital, Lanzhou, Gansu, People's Republic of China.

Abstract

Purpose: This study aimed to determine the risk factors associated with the number of thrombectomy device passes and establish a nomogram for predicting the number of device pass attempts in patients with successful endovascular thrombectomy (EVT).

Methods: We enrolled patients from a signal comprehensive stroke center (CSC) who underwent EVT because of large vessel occlusion stroke. Multivariate logistic regression analysis was used to develop the best-fit nomogram for predicting the number of thrombectomy device passes. The discrimination and calibration of the nomogram were estimated using the area under the receiver operating characteristic curve (AUC-ROC) and a calibration plot with a bootstrap of 1000 resamples. A decision curve analysis (DCA) was used to measure the availability and effect of this predictive tool.

Results: In total, 130 patients (mean age 64.9 ± 11.1 years; 83 males) were included in the final analysis. Age (odds ratio [OR], 1.085; 95% confidence interval [CI], 1.005-1.172; p = 0.036), baseline Alberta Stroke Program Early computed tomography (ASPECTS) score (OR, 0.237; 95% CI, 0.115-0.486; p < 0.001), and homocysteine level (OR, 1.090; 95% CI, 1.028-1.155; p = 0.004) were independent predictors of device pass number and were thus incorporated into the nomogram. The AUC-ROC determined the discrimination ability of the nomogram, which was 0.921 (95% CI, 0.860-0.980), which indicated good predictive power. Moreover, the calibration plot revealed good predictive accuracy of the nomogram. The DCA demonstrated that when the threshold probabilities of the cohort ranged between 5.0% and 98.0%, the use of the nomogram to predict a device pass number > 3 provided greater net benefit than did "treat all" or "treat none" strategies.

Conclusion: The nomogram comprised age, baseline ASPECTS score, and homocysteine level, can predict a device pass number >3 in acute ischemic stroke (AIS) patients who are undergoing EVT.

Keywords: acute ischemic stroke; endovascular thrombectomy; nomogram; stentriever.

Grants and funding

This work was supported by the Lanzhou Talent Innovation and Entrepreneurship Project, China (2017-RC-57). The funders had no role in the study design, data collection, analysis, decision to publish, or preparation of the manuscript.