Abstract
Objective: To explore the association between ultrasound parameters and previous ischemic or hemorrhagic stroke in patients with moyamoya disease (MMD), and develop an ultrasound-based nomogram to identify stroke in patients with MMD.Methods: We prospectively enrolled 52 consecutive patients (92 hemispheres) with MMD at the Beijing Tiantan Hospital. Thirty-six patients (65 hemispheres) were assigned to the training dataset from September 2019 to February 2020, and 16 patients (27 hemispheres) were assigned to the validation dataset from March 2020 to July 2020. Multivariate logistic regression analysis was applied to identify ultrasound parameters associated with previous history of ipsilateral stroke in patients with MMD, and a nomogram was subsequently constructed to identify stroke in patients with MMD. The performance of the nomogram was evaluated with respect to discrimination, calibration, and clinical usefulness.Results: Multivariate analysis indicated that the flow volume (FV) of the extracranial internal carotid artery (EICA) and the peak systolic velocity (PSV) of the posterior cerebral artery (PCA) were independently associated with ipsilateral stroke in patients with MMD, a nomogram incorporating these two parameters was constructed to identify stroke patients. The area under the receiver operating characteristic (AUROC) curves was 0.776 (95% CI, 0.656–0.870) in the training dataset and 0.753 (95% CI, 0.550–0.897) in the validation dataset suggested that the model had good discrimination ability. The calibration plot showed good agreement in both the two datasets. The decision curve analysis (DCA) revealed that the nomogram was clinically useful.Conclusions: Ultrasound parameters of EICA and PCA are independently associated with history of previous ipsilateral ischemic or hemorrhagic stroke in patients with MMD. The present ultrasound-based nomogram might provide information to identify MMD patients with high risk of stroke. Future long-term follow-up studies are needed to prove the predictive value in other independent cohorts.Clinical Trial Registration: http://www.chictr.org.cn/index.aspx. Unique Identifier: ChiCTR1900026075.
Highlights
Moyamoya disease (MMD), which is a rare disease with unknown etiology, predisposes some patients to stroke
Multivariate analysis indicated that the flow volume (FV) of the extracranial internal carotid artery (EICA) and the peak systolic velocity (PSV) of the posterior cerebral artery (PCA) were independently associated with ipsilateral stroke in patients with MMD, a nomogram incorporating these two parameters was constructed to identify stroke patients
Ultrasound parameters of EICA and PCA are independently associated with history of previous ipsilateral ischemic or hemorrhagic stroke in patients with MMD
Summary
Moyamoya disease (MMD), which is a rare disease with unknown etiology, predisposes some patients to stroke. It is characterized by progressive stenosis of the terminal portions of the internal carotid arteries and their proximal branches. Leptomeningeal collateral vessels from the posterior cerebral artery (PCA) are regarded as the main collateral vessels in patients with MMD, and transdural collaterals from the branches of external carotid artery (ECA), including middle meningeal artery, maxillary artery (MA), superficial temporal artery (STA) can compensate for ischemia in the brain [1, 3, 4]. Cerebral ischemia and intracranial bleeding are the main hazards of MMD [2, 5]. Studies have shown that regular imaging examination in patients with unilateral MMD can significantly reduce the burden of stroke and improve the clinical prognosis [2, 6]
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have