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Purpose <p>Early and severe (ES) midline shift (MLS ≥ 10&#xa0;mm) simultaneously occurring within 24&#xa0;h after endovascular thrombectomy (EVT) is a life-threatening emergency that requires immediate intervention. This study aims to describe ES-MLS and develop a predictive model in patients with anterior circulation occlusion who have undergone EVT.</p> Methods <p>This retrospective cohort study utilized data from a prospective registry. Functional outcome was defined as a modified Rankin Scale score of 0–2. Radiomic features extracted from pre-EVT diffusion-weighted imaging were subjected to LASSO regression with fourfold cross-validation. Clinical features were selected via multivariable regression and integrated into a nomogram, with performance evaluated through receiver operating characteristic curve analysis in both training and validation datasets.</p> Results <p>A total of 481 patients (median age 68 [IQR 58–76], 39.7% female) were included in this study, which consisted of a training dataset (n = 361) and a validation dataset (n = 120). In the ES-MLS group, 85.7% had died and none had a functional outcome at the 90-day follow-up. Recanalization, NIHSS score, and two radiomic features were identified as factors associated with ES-MLS in the nomogram. The predictive model exhibited an area under the curve (AUC) of 0.844 (95% confidence interval [CI], 0.803–0.880) in the training dataset and 0.823 (95% CI, 0.743–0.887) in the validation dataset.</p> Conclusion <p>This is the initial structured overview of ES-MLS after EVT, featuring a model designed for personalized prediction of ES-MLS. The tool may enhance patient selection before EVT and refine the aggressive monitoring strategy after EVT.</p>

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Predicting early severe midline shift in acute ischemic stroke Within 24 h of endovascular thrombectomy

  • 期刊论文

  • 发表日期：

    2025年11月7日

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  • Nannan Han,
  • Xiaobo Zhang,
  • Yu Zhang,
  • Leshi Zhang,
  • Haojun Ma,
  • Tengfei Li,
  • Xudong Yan,
  • Zhi Chen,
  • Ying Lu,
  • Song Wang,
  • Ruomeng Chai,
  • Li Wang,
  • Zhen Wang,
  • Ye Cheng,
  • Wenzhen Shi,
  • Gejuan Zhang,
  • Ye Tian,
  • Mingze Chang

摘要

Purpose

Early and severe (ES) midline shift (MLS ≥ 10 mm) simultaneously occurring within 24 h after endovascular thrombectomy (EVT) is a life-threatening emergency that requires immediate intervention. This study aims to describe ES-MLS and develop a predictive model in patients with anterior circulation occlusion who have undergone EVT.

Methods

This retrospective cohort study utilized data from a prospective registry. Functional outcome was defined as a modified Rankin Scale score of 0–2. Radiomic features extracted from pre-EVT diffusion-weighted imaging were subjected to LASSO regression with fourfold cross-validation. Clinical features were selected via multivariable regression and integrated into a nomogram, with performance evaluated through receiver operating characteristic curve analysis in both training and validation datasets.

Results

A total of 481 patients (median age 68 [IQR 58–76], 39.7% female) were included in this study, which consisted of a training dataset (n = 361) and a validation dataset (n = 120). In the ES-MLS group, 85.7% had died and none had a functional outcome at the 90-day follow-up. Recanalization, NIHSS score, and two radiomic features were identified as factors associated with ES-MLS in the nomogram. The predictive model exhibited an area under the curve (AUC) of 0.844 (95% confidence interval [CI], 0.803–0.880) in the training dataset and 0.823 (95% CI, 0.743–0.887) in the validation dataset.

Conclusion

This is the initial structured overview of ES-MLS after EVT, featuring a model designed for personalized prediction of ES-MLS. The tool may enhance patient selection before EVT and refine the aggressive monitoring strategy after EVT.