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Original research
Development and validation of a nomogram for cerebral hemorrhage in patients with carotid stenosis undergoing stenting: a multicenter retrospective study
  1. Xianjun Zhang1,
  2. Xiaoliang Wang2,
  3. Teng Ma3,
  4. Wentao Gong4,
  5. Yong Zhang1,
  6. Naidong Wang1
    1. 1Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
    2. 2Department of Neurology, Qingdao Municipal Hospital Group, Qingdao, Shandong, China
    3. 3Department of Neurology, Qingdao Hiser Hospital, Qingdao, Shandong, China
    4. 4Department of Neurointervention, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
    1. Correspondence to Professor Naidong Wang; wangnaidong163{at}163.com; Professor Yong Zhang; bravezhang{at}126.com

    Abstract

    Background Hyperperfusion-induced cerebral hemorrhage (HICH) is a rare but severe complication in patients with carotid stenosis undergoing stent placement for which predictive models are lacking. Our objective was to develop a nomogram to predict such risk.

    Methods We included a total of 1226 patients with carotid stenosis who underwent stenting between June 2015 and December 2022 from three medical centers, divided into a development cohort of 883 patients and a validation cohort of 343 patients. The model used LASSO regression for feature optimization and multivariable logistic regression to develop the predictive model. Model accuracy was assessed via the receiver operating characteristic curve, with further evaluation of calibration and clinical utility through calibration curves and decision curve analysis (DCA). The model underwent internal validation using bootstrapping and external validation with the validation cohort.

    Results Older age (OR 1.07, p=0.005), higher degrees of carotid stenosis (OR 1.07, p=0.006), poor collateral circulation (OR 6.26, p<0.001), elevated preoperative triglyceride levels (OR 1.27, p=0.041) and neutrophil counts (OR 1.36, p<0.001) were identified as independent risk factors for HICH during hospitalization. The nomogram constructed based on these predictive factors demonstrated an area under the curve (AUC) of 0.817. The AUCs for internal and external validation were 0.809 and 0.783, respectively. Calibration curves indicated good model fit, and DCA confirmed substantial clinical net benefit in both cohorts.

    Conclusion We developed and validated a nomogram to predict HICH in patients with carotid stenosis post-stenting, facilitating early identification and preventive intervention in high-risk individuals.

    • Stenosis
    • Stent
    • Hemorrhage

    Data availability statement

    Data are available upon reasonable request. The data supporting the conclusions of this study are available from the corresponding author upon reasonable request at wangnaidong163@163.com.

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    Data availability statement

    Data are available upon reasonable request. The data supporting the conclusions of this study are available from the corresponding author upon reasonable request at wangnaidong163@163.com.

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    Footnotes

    • XZ, XW and TM are joint first authors.

    • XZ, XW and TM contributed equally.

    • Contributors All the coauthors contributed to the study being published, and read and reviewed the manuscript and approved its publication. Guarantors: NW. Concept design: XZ, XW, TM. Drafting manuscript: XZ, XW, TM. Data acquisition, revision, editing, approval of final draft: XZ, XW, TM, WG, YZ, NW. Data analysis: XZ. During the preparation of this work, the authors used ChatGPT-4 to improve the language and writing quality. After using this tool, the authors reviewed and edited the content as necessary and take full responsibility for the final content of the publication.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.