The ACORNS grading scale: a novel tool for the prediction of malignant brain edema after endovascular thrombectomy.
J Neurointerv Surg
; 15(e2): e190-e197, 2023 Nov.
Article
em En
| MEDLINE
| ID: mdl-36207112
ABSTRACT
BACKGROUND:
To develop and validate a novel tool for predicting the development of malignant brain edema (MBE) in large vessel occlusion stroke patients after endovascular thrombectomy (EVT).METHODS:
We used a prospectively registered population of EVT patients from three comprehensive stroke centers. The population was randomly divided into two subsets (73) a training cohort and an internal validation cohort. External validation was performed using the Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke Registry in China (ACTUAL) database. MBE was defined as (1) hypodense parenchyma in at least 50% of the middle cerebral artery and signs of local brain swelling, and (2) a midline shift of ≥5 mm at the septum pellucidum or pineal gland with obliteration of the basal cisterns. The model was constructed using logistic regression analysis. The performance of the model was examined in terms of discrimination and calibration.RESULTS:
After adjusting for other confounders, baseline National Institutes of Health Stroke Scale (NIHSS) and Alberta Stroke Program Early CT (ASPECT) scores, a clinical history of hypertension, collateral status, intravenous thrombolysis before thrombectomy, fasting blood glucose, reperfusion status, and occlusion site were found to be independent predictors of MBE. These variables were combined to create the ACORNS grading scale. The areas under the curve in receiver operating curve analysis were 0.850 (95% CI 0.816 to 0.884), 0.874 (95% CI 0.821 to 0.926), and 0.785 (95% CI 0.740 to 0.829) for the training, internal validation, and external validation cohorts, respectively, indicating good discriminative performance in the validation cohorts.CONCLUSIONS:
The ACORNS grading scale is an accurate and easily applicable model for the prediction of the development of MBE after EVT.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Edema Encefálico
/
Isquemia Encefálica
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Acidente Vascular Cerebral
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Procedimentos Endovasculares
Tipo de estudo:
Prognostic_studies
/
Risk_factors_studies
Limite:
Humans
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article