Risk stratification in symptomatic intracranial atherosclerotic disease with conventional vascular risk factors and cerebral haemodynamics

作     者：Xuan Tian Hui Fang Linfang Lan Hing Lung Ip Jill Abrigo Haipeng Liu Lina Zheng Florence S Y Fan Sze Ho Ma Bonaventure Ip Bo Song Yuming Xu Jingwei Li Bing Zhang Yun Xu Yannie O Y Soo Vincent Mok Ka Sing Wong Thomas W Leung Xinyi Leng 

作者机构：Department of Medicine and TherapeuticsThe Chinese UniversityHong KongChina Department of NeurologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina Department of NeurologyThe First Affiliated Hospital of Sun Yat-sen UniversityGuangzhouGuangdongChina Department of Imaging and InterventionalThe Chinese UniversityHong KongChina Research Centre of Intelligent HealthcareFaculty of Health and Life ScienceCoventry UniversityCoventryUK Department of NeurologyNanjing University Medical School Affiliated Nanjing Drum Tower HospitalNanjingJiangsuChina Department of RadiologyNanjing University Medical School Affiliated Nanjing Drum Tower HospitalNanjingJiangsuChina 

出 版 物：《Stroke & Vascular Neurology》 (卒中与血管神经病学（英文）)

年 卷 期：2023年第8卷第1期

页      面：77-85页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

基　　金：the Direct Grant for Research,The Chinese University of Hong Kong(Reference No.2019.033) General Research Fund,Research Grants Council of Hong Kong(Reference number 14106019) 

主　　题：intracranial otherwise stratification 

摘      要：Background and purpose Symptomatic intracranial atherosclerotic stenosis(sICAS)is associated with a considerable risk of recurrent stroke despite contemporarily optimal medical *** of luminal stenosis in sICAS and its haemodynamic significance quantified with computational fluid dynamics(CFD)models were associated with the risk of stroke *** aimed to develop and compare stroke risk prediction nomograms in sICAS,based on vascular risk factors and these *** Patients with 50%-99%sICAS confirmed in CT angiography(CTA)were *** vascular risk factors were *** 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 *** 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 *** Among 245 sICAS patients,20(8.2%)had *** 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 *** analysis in patients with anterior-circulation sICAS showed similar *** The D2H2A nomogram,incorporating conventional vascular risk factors and the haemodynamic significance of sICAS a