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Transient Middle Cerebral Artery Occlusion Model of Stroke
Published on: August 11, 2023
ZJUSXH Model: A Multilayer Model for Predicting 90-Day Neurological Outcome After Endovascular Thrombectomy in Acute
Jianli Wang1, Feng Yang2, Chengdong Sun3
1Department of Neurosurgery.
Objectives:
Stroke is a leading cause of mortality and disability worldwide, particularly acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Although endovascular intervention has proven effective, individual outcomes vary considerably. This study aimed to identify key prognostic factors and develop a predictive model for neurological recovery in patients with LVO-AIS following endovascular thrombectomy (EVT).
Methods:
A total of 191 LVO-AIS patients who underwent EVT at the Neurosurgery Department of Zhejiang University Shaoxing Hospital from January 2022 to June 2023 were included in the analysis. Prognostic factors collected included demographic information, premorbid characteristics, initial laboratory data, neurological evaluation, and others. The 90‑day modified Rankin Scale (mRS) score served as the primary clinical outcome. A multilevel prognostic (MLP) model and an associated nomogram were developed to identify significant predictors and visualize their individual contributions to the outcome.
Results:
The Zhejiang University Shaoxing Hospital (ZJUSXH) model was developed, incorporating 11 key predictors: the National Institutes of Health Stroke Scale (NIHSS) score, symptom onset‑to‑recanalization (OTR) time, fasting blood glucose (FBS), hemoglobin (HGB), serum albumin (ALB), symptomatic intracerebral hemorrhage (sICH), the Controlling Nutritional Status (CONUT) score, the prognostic nutritional index (PNI), swallowing function, and the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification. The overall predictive accuracy of the model was 86.2%.
Conclusion:
The NIHSS score and OTR time emerged as the most critical prognostic factors. FBS, HGB, ALB, sICH, swallowing function, and TOAST classification were also significant predictors. In addition, the CONUT score and PNI showed a significant association with neurological outcomes. Both the developed ZJUSXH model and its corresponding nomogram demonstrated high predictive accuracy.