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Development and validation of a dynamic nomogram for predicting poor outcomes in patients with internal carotid

Lingyu Zhang1,2, Zhixi Wang3, Lingshan Wu3

  • 11Department of Neurology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, China.

Journal of Neurosurgery
|January 22, 2026
PubMed

Insights

A new nomogram predicts poor outcomes for patients with internal carotid artery occlusion (ICAO) undergoing endovascular therapy (EVT). This tool aids physicians in making critical decisions for stroke patients with ICAO.

Area of Science:

  • Neurology
  • Interventional Neuroradiology
  • Vascular Surgery

Background:

  • Internal carotid artery occlusion (ICAO) presents significant challenges in endovascular therapy (EVT) due to high thrombosis burden and compromised collateral circulation.
  • Patients with ICAO undergoing EVT often face unfavorable outcomes, necessitating better predictive tools for risk stratification.

Purpose of the Study:

  • To identify independent risk factors associated with poor outcomes in patients with ICAO undergoing EVT.
  • To develop and validate a dynamic nomogram for predicting poor outcomes in this patient population.

Main Methods:

  • A retrospective analysis of 577 patients from the MARVEL trial (training and internal validation cohorts) and 281 patients from the ACTUAL registry (external validation cohort).
  • Least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression were used to identify significant risk factors.
  • A dynamic nomogram prediction model was constructed and validated.

Main Results:

  • Five factors independently predicted poor outcomes: age, baseline Alberta Stroke Programme Early CT Score, baseline National Institutes of Health Stroke Scale score, baseline American Society of Interventional and Therapeutic Neuroradiology and Society of Interventional Radiology grade, and baseline glucose levels.
  • The nomogram demonstrated moderate predictive performance with an area under the curve of 0.786 (internal validation) and 0.795 (external validation).
  • Calibration curves showed close alignment with the ideal diagonal line, indicating good model fit.

Conclusions:

  • The developed predictive model accurately forecasts poor outcomes for patients with ICAO undergoing EVT.
  • This dynamic nomogram serves as a valuable adjunct for physicians and patients' families in operative decision-making.
Abstract

Keywords:
acute ischemic strokedynamic nomogramendovascular neurosurgeryendovascular therapyinternal carotid artery occlusionvascular disorders

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