Development and Validation of a Nomogram for Predicting Poor Outcome in Spontaneous Cervical Artery Dissection

Area of Science:

• Neurology
• Vascular Medicine
• Medical Imaging

Background:

• Spontaneous cervical artery dissection (sCAD) is a significant cause of stroke in younger adults.
• Accurate prognostic assessment is crucial for guiding clinical management and improving patient outcomes.
• Current risk stratification tools for sCAD are limited, necessitating the development of novel predictive models.

Purpose of the Study:

• To develop and internally validate a preliminary nomogram for predicting poor prognosis in patients with spontaneous cervical artery dissection (sCAD).
• To evaluate the statistical performance, including discrimination and calibration, of the developed nomogram.
• To identify potential clinical and imaging variables associated with poor outcomes in sCAD.

Main Methods:

• Retrospective analysis of 75 patients diagnosed with sCAD between November 2013 and April 2024.
• Poor prognosis defined as acute cerebral infarction or hemorrhage.
• A multivariate logistic regression model was constructed using variables with p<0.2 in univariate analysis and internally validated with 1000 bootstrap resamples.

Main Results:

• The final nomogram included CAD type (non-intramural hematoma), sex, hypertension, and hyperhomocysteinemia.
• Only non-intramural hematoma CAD type showed statistical significance (OR=13.41, P<0.01).
• The model demonstrated moderate discrimination (AUC=0.788) and acceptable calibration (χ2=8.11, P=0.23) upon internal validation.

Conclusions:

• Ultrasonographic CAD type combined with clinical variables may aid in predicting sCAD outcomes.
• The preliminary nomogram requires multi-center prospective validation in a larger cohort (at least 400 patients) due to small sample size and lack of external validation.
• The current model is not ready for clinical application but generates a hypothesis for future research.