Risk stratification in symptomatic intracranial atherosclerotic disease with conventional vascular risk factors and cerebral haemodynamics
Background and purpose Symptomatic intracranial atherosclerotic stenosis (sICAS) is associated with a considerable risk of recurrent stroke despite contemporarily optimal medical treatment. Severity of luminal stenosis in sICAS and its haemodynamic significance quantified with computational fluid dy...
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
|
| Series: | Stroke and Vascular Neurology |
| Online Access: | https://svn.bmj.com/content/early/2022/09/14/svn-2022-001606.full |
| _version_ | 1811205956098326528 |
|---|---|
| author | Xinyi Leng Hui Fang Bo Song Yuming Xu Hing Lung Ip Sze Ho Ma Vincent Mok Thomas W Leung Bing Zhang Jingwei Li Yun Xu Linfang Lan Bonaventure Ip Lina Zheng Jill Abrigo Ka Sing Wong Yannie O Y Soo Xuan Tian Haipeng Liu Florence S Y Fan |
| author_facet | Xinyi Leng Hui Fang Bo Song Yuming Xu Hing Lung Ip Sze Ho Ma Vincent Mok Thomas W Leung Bing Zhang Jingwei Li Yun Xu Linfang Lan Bonaventure Ip Lina Zheng Jill Abrigo Ka Sing Wong Yannie O Y Soo Xuan Tian Haipeng Liu Florence S Y Fan |
| author_sort | Xinyi Leng |
| collection | DOAJ |
| description | Background and purpose Symptomatic intracranial atherosclerotic stenosis (sICAS) is associated with a considerable risk of recurrent stroke despite contemporarily optimal medical treatment. Severity of luminal stenosis in sICAS and its haemodynamic significance quantified with computational fluid dynamics (CFD) models were associated with the risk of stroke recurrence. We aimed to develop and compare stroke risk prediction nomograms in sICAS, based on vascular risk factors and these metrics.Methods Patients with 50%–99% sICAS confirmed in CT angiography (CTA) were enrolled. Conventional vascular risk factors were collected. Severity of luminal stenosis in sICAS was dichotomised as moderate (50%–69%) and severe (70%–99%). Translesional pressure ratio (PR) and wall shear stress ratio (WSSR) were quantified via CTA-based CFD modelling; the haemodynamic status of sICAS was classified as normal (normal PR&WSSR), intermediate (otherwise) and abnormal (abnormal PR&WSSR). All patients received guideline-recommended medical treatment. We developed and compared performance of nomograms composed of these variables and independent predictors identified in multivariate logistic regression, in predicting the primary outcome, recurrent ischaemic stroke in the same territory (SIT) within 1 year.Results Among 245 sICAS patients, 20 (8.2%) had SIT. The D2H2A nomogram, incorporating diabetes, dyslipidaemia, haemodynamic status of sICAS, hypertension and age ≥50 years, showed good calibration (P for Hosmer-Lemeshow test=0.560) and discrimination (C-statistic 0.73, 95% CI 0.60 to 0.85). It also had better performance in risk reclassification and provided larger net benefits in decision curve analysis, compared with nomograms composed of conventional vascular risk factors only, and plus the severity of luminal stenosis in sICAS. Sensitivity analysis in patients with anterior-circulation sICAS showed similar results.Conclusions The D2H2A nomogram, incorporating conventional vascular risk factors and the haemodynamic significance of sICAS as assessed in CFD models, could be a useful tool to stratify sICAS patients for the risk of recurrent stroke under contemporarily optimal medical treatment. |
| first_indexed | 2024-04-12T03:39:54Z |
| format | Article |
| id | doaj.art-6dc79d9fa2354d7bbe2ce16116779a00 |
| institution | Directory Open Access Journal |
| issn | 2059-8696 |
| language | English |
| last_indexed | 2024-04-12T03:39:54Z |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Stroke and Vascular Neurology |
| spelling | doaj.art-6dc79d9fa2354d7bbe2ce16116779a002022-12-22T03:49:19ZengBMJ Publishing GroupStroke and Vascular Neurology2059-869610.1136/svn-2022-001606Risk stratification in symptomatic intracranial atherosclerotic disease with conventional vascular risk factors and cerebral haemodynamicsXinyi Leng0Hui Fang1Bo Song2Yuming Xu3Hing Lung Ip4Sze Ho Ma5Vincent Mok6Thomas W Leung7Bing Zhang8Jingwei Li9Yun Xu10Linfang Lan11Bonaventure Ip12Lina Zheng13Jill Abrigo14Ka Sing Wong15Yannie O Y Soo16Xuan Tian17Haipeng Liu18Florence S Y Fan19Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China1 School of Kinesiology, Shanghai University of Sport, Shanghai, ChinaCollege of Physical Education and Sports, Beijing Normal University, Beijing, China2 Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, ChinaDepartment of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, ChinaDepartment of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China2 Gerald Choa Neuroscience Centre, Therese Pei Fong Chow Research Centre for Prevention of Dementia, Lui Che Woo Institute of Innovative Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong KongDepartment of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China1 Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan1 Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, ChinaDepartment of Neurology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, Jiangsu, China1 Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, ChinaDivision of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong KongDepartment of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, China2 Department of Diagnostic Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong KongDepartment of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, PR ChinaDepartment of Medicine and Therapeutics, The Chinese University, Hong Kong, ChinaDepartment of Medicine and Therapeutics, The Chinese University, Hong Kong, ChinaDepartment of Medicine and Therapeutics, The Chinese University, Hong Kong, ChinaDepartment of Medicine and Therapeutics, The Chinese University, Hong Kong, ChinaBackground and purpose Symptomatic intracranial atherosclerotic stenosis (sICAS) is associated with a considerable risk of recurrent stroke despite contemporarily optimal medical treatment. Severity of luminal stenosis in sICAS and its haemodynamic significance quantified with computational fluid dynamics (CFD) models were associated with the risk of stroke recurrence. We aimed to develop and compare stroke risk prediction nomograms in sICAS, based on vascular risk factors and these metrics.Methods Patients with 50%–99% sICAS confirmed in CT angiography (CTA) were enrolled. Conventional vascular risk factors were collected. Severity of luminal stenosis in sICAS was dichotomised as moderate (50%–69%) and severe (70%–99%). Translesional pressure ratio (PR) and wall shear stress ratio (WSSR) were quantified via CTA-based CFD modelling; the haemodynamic status of sICAS was classified as normal (normal PR&WSSR), intermediate (otherwise) and abnormal (abnormal PR&WSSR). All patients received guideline-recommended medical treatment. We developed and compared performance of nomograms composed of these variables and independent predictors identified in multivariate logistic regression, in predicting the primary outcome, recurrent ischaemic stroke in the same territory (SIT) within 1 year.Results Among 245 sICAS patients, 20 (8.2%) had SIT. The D2H2A nomogram, incorporating diabetes, dyslipidaemia, haemodynamic status of sICAS, hypertension and age ≥50 years, showed good calibration (P for Hosmer-Lemeshow test=0.560) and discrimination (C-statistic 0.73, 95% CI 0.60 to 0.85). It also had better performance in risk reclassification and provided larger net benefits in decision curve analysis, compared with nomograms composed of conventional vascular risk factors only, and plus the severity of luminal stenosis in sICAS. Sensitivity analysis in patients with anterior-circulation sICAS showed similar results.Conclusions The D2H2A nomogram, incorporating conventional vascular risk factors and the haemodynamic significance of sICAS as assessed in CFD models, could be a useful tool to stratify sICAS patients for the risk of recurrent stroke under contemporarily optimal medical treatment.https://svn.bmj.com/content/early/2022/09/14/svn-2022-001606.full |
| spellingShingle | Xinyi Leng Hui Fang Bo Song Yuming Xu Hing Lung Ip Sze Ho Ma Vincent Mok Thomas W Leung Bing Zhang Jingwei Li Yun Xu Linfang Lan Bonaventure Ip Lina Zheng Jill Abrigo Ka Sing Wong Yannie O Y Soo Xuan Tian Haipeng Liu Florence S Y Fan Risk stratification in symptomatic intracranial atherosclerotic disease with conventional vascular risk factors and cerebral haemodynamics Stroke and Vascular Neurology |
| title | Risk stratification in symptomatic intracranial atherosclerotic disease with conventional vascular risk factors and cerebral haemodynamics |
| title_full | Risk stratification in symptomatic intracranial atherosclerotic disease with conventional vascular risk factors and cerebral haemodynamics |
| title_fullStr | Risk stratification in symptomatic intracranial atherosclerotic disease with conventional vascular risk factors and cerebral haemodynamics |
| title_full_unstemmed | Risk stratification in symptomatic intracranial atherosclerotic disease with conventional vascular risk factors and cerebral haemodynamics |
| title_short | Risk stratification in symptomatic intracranial atherosclerotic disease with conventional vascular risk factors and cerebral haemodynamics |
| title_sort | risk stratification in symptomatic intracranial atherosclerotic disease with conventional vascular risk factors and cerebral haemodynamics |
| url | https://svn.bmj.com/content/early/2022/09/14/svn-2022-001606.full |
| work_keys_str_mv | AT xinyileng riskstratificationinsymptomaticintracranialatheroscleroticdiseasewithconventionalvascularriskfactorsandcerebralhaemodynamics AT huifang riskstratificationinsymptomaticintracranialatheroscleroticdiseasewithconventionalvascularriskfactorsandcerebralhaemodynamics AT bosong riskstratificationinsymptomaticintracranialatheroscleroticdiseasewithconventionalvascularriskfactorsandcerebralhaemodynamics AT yumingxu riskstratificationinsymptomaticintracranialatheroscleroticdiseasewithconventionalvascularriskfactorsandcerebralhaemodynamics AT hinglungip riskstratificationinsymptomaticintracranialatheroscleroticdiseasewithconventionalvascularriskfactorsandcerebralhaemodynamics AT szehoma riskstratificationinsymptomaticintracranialatheroscleroticdiseasewithconventionalvascularriskfactorsandcerebralhaemodynamics AT vincentmok riskstratificationinsymptomaticintracranialatheroscleroticdiseasewithconventionalvascularriskfactorsandcerebralhaemodynamics AT thomaswleung riskstratificationinsymptomaticintracranialatheroscleroticdiseasewithconventionalvascularriskfactorsandcerebralhaemodynamics AT bingzhang riskstratificationinsymptomaticintracranialatheroscleroticdiseasewithconventionalvascularriskfactorsandcerebralhaemodynamics AT jingweili riskstratificationinsymptomaticintracranialatheroscleroticdiseasewithconventionalvascularriskfactorsandcerebralhaemodynamics AT yunxu riskstratificationinsymptomaticintracranialatheroscleroticdiseasewithconventionalvascularriskfactorsandcerebralhaemodynamics AT linfanglan riskstratificationinsymptomaticintracranialatheroscleroticdiseasewithconventionalvascularriskfactorsandcerebralhaemodynamics AT bonaventureip riskstratificationinsymptomaticintracranialatheroscleroticdiseasewithconventionalvascularriskfactorsandcerebralhaemodynamics AT linazheng riskstratificationinsymptomaticintracranialatheroscleroticdiseasewithconventionalvascularriskfactorsandcerebralhaemodynamics AT jillabrigo riskstratificationinsymptomaticintracranialatheroscleroticdiseasewithconventionalvascularriskfactorsandcerebralhaemodynamics AT kasingwong riskstratificationinsymptomaticintracranialatheroscleroticdiseasewithconventionalvascularriskfactorsandcerebralhaemodynamics AT yannieoysoo riskstratificationinsymptomaticintracranialatheroscleroticdiseasewithconventionalvascularriskfactorsandcerebralhaemodynamics AT xuantian riskstratificationinsymptomaticintracranialatheroscleroticdiseasewithconventionalvascularriskfactorsandcerebralhaemodynamics AT haipengliu riskstratificationinsymptomaticintracranialatheroscleroticdiseasewithconventionalvascularriskfactorsandcerebralhaemodynamics AT florencesyfan riskstratificationinsymptomaticintracranialatheroscleroticdiseasewithconventionalvascularriskfactorsandcerebralhaemodynamics |