A nomogram for predicting malignant middle cerebral artery infarction after thrombectomy in large core infarction​.

BACKGROUND: Malignant middle cerebral artery infarction (mMCAi) is a life-threatening complication after large hemispheric infarction. This study aimed to develop a nomogram combining clinical and Computed Tomography Perfusion (CTP) parameters to predict the risk of mMCAi in patients with large core infarction following endovascular treatment (EVT). METHODS: We retrospectively analyzed patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO) and large core infarction treated with EVT between January 2019 and June 2024. Demographic, clinical, imaging, and procedural data were collected. Multivariate logistic regression with forward elimination identified independent predictors of mMCAi. A nomogram was constructed based on these predictors, and its performance was assessed using the area under the receiver operating characteristic curve (AUC) and calibration analysis. RESULTS: Among 179 patients, 45 (25.2%) developed mMCAi after EVT. Atrial fibrillation (AF) (odds ratio [OR]=3.551, 95% confidence interval [CI]: 1.381–9.127), National Institutes of Health Stroke Scale (NIHSS) score (OR=1.130 per point, 95% CI: 1.062–1.202), serum glucose (OR=1.315 per mmol/L, 95% CI: 1.116–1.550), and ischemic core volume (relative Cerebral Blood Flow [rCBF] <30%, OR=1.027 per mL, 95% CI: 1.014–1.039) were independently associated with increased risk of mMCAi. modified First-Pass Effect (mFPE) was protective (OR=0.325, 95% CI: 0.114–0.926). The nomogram incorporating these variables showed excellent discrimination (AUC=0.894, 95% CI: 0.843–0.944), and the calibration curve showed a high concordance between predicted and actual risk (Hosmer-Lemeshow test p=0.842). CONCLUSIONS: Independent predictors of mMCAi included NIHSS score, AF, serum glucose level, ischemic core volume on CTP, and mFPE. The nomogram provides a practical and accurate tool for predicting mMCAi following EVT in patients with large core infarction.