High-resolution Vessel Wall Imaging-based Construction To Predict Carotid Artery Dissection Vessels Recanalization Nomogram Study

Objective:We analyzed the general characteristics of intermural hematoma-type carotid artery dissection by high-resolution vessel wall imaging,explored the factors associated with revascularization,and constructed nomograms to predict the possible regression of revascularization in carotid artery dissection.Methods:Retrospective analysis of clinical data and imaging data of patients with intramural haematoma-type carotid artery dissection admitted through the Department of Neurology,First Hospital of Jilin University from 1January 2014 to 31 May 2022,including age,gender,history of stroke,history of migraine,hyperhomocysteinemia,hypercholesterolemia,coronary heart disease,history of alcohol consumption,history of smoking,admission NIHSS score,discharge NIHSS score,treatment modality,length of hospital stay,time from onset of symptoms to admission,single or multiple vessel dissection,intermural haematoma signal,degree of luminal stenosis,and length of vessel involved in the dissection.All patients with dissection underwent high-resolution vessel wall imaging on admission,and the endpoint event for follow-up was lumen recanalisation or a follow-up period of >1 year.Continuous variables were pooled as mean ± standard deviation(SD)and an independent sample t-test was used if the variables conformed to a normal distribution,or a rank sum test if they did not.Categorical variables were expressed as percentages and a chi-square test was used.SPSS 26.0 was used for statistical analysis and all reported p-values were two-sided,with p-values < 0.05 being significant.The final column line graphs of the clinical prediction models were constructed from the results of the multifactorial logistic regression analysis to provide a more visual assessment tool for the clinic.ResultsA total of 129 patients with a total of 168 vessels were included in this study,of which 108 patients with a total of 141 vessels were included in the training set and 21 patients with a total of 27 vessels were included in the external validation set.The revascularization rate was 45.4% for the training set and 59.3% for the validation set.The results of univariate analysis showed statistically significant differences in the proportions of age,hypertension,smoking,type of intramural haematoma signal and degree of luminal stenosis between the revascularised and nonrevascularised groups(p<0.05).The results of the multifactorial logistic regression analysis showed that age,smoking,degree of stenosis,and type of intramural haematoma signal were risk factors associated with revascularisation.Age(OR=0.958,95% CI: 0.928-0.987,P=0.006),smoking(OR=0.353,95% CI: 0.161-0.774,P=0.009),and vessel occlusion(OR=0.149,95% CI: 0.046-0.477,P=0.001)were negatively associated with complete revascularisation,and Very high signal intermural haematoma(OR=5.149,95% CI: 1.914-13.849,P=0.001)was positively correlated with revascularisation.According to the above related factors,the Nomogram for predicting vascular recanalization was established and verified externally Conclusions:Based on the results of a multifactorial analysis,we have developed a nomogram to predict revascularisation of carotid artery dissection.It can be visualised that in young patients with carotid artery dissection without a history of smoking and with mild lumen stenosis,timely anticoagulation or antiplatelet therapy can help to improve the lumen revascularisation rate,which is important for the early assessment and improvement of the prognosis of patients with carotid artery dissection.