Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Oct 24;47(1):817.
doi: 10.1007/s10143-024-03051-2.

Long-term outcome followed for more than 5 years after revascularization surgery for the treatment of atherosclerotic steno-occlusive disease: poor outcome prediction using machine learning and analysis of the results

June Ho Choi  1 , Minwoo Kim  1 , Jung Cheol Park  1 , Jae Sung Ahn  1 , Byung Duk Kwun  1 , Wonhyoung Park  2
Affiliations

Long-term outcome followed for more than 5 years after revascularization surgery for the treatment of atherosclerotic steno-occlusive disease: poor outcome prediction using machine learning and analysis of the results

June Ho Choi et al. Neurosurg Rev. .

Abstract

Cerebral revascularization for the treatment of atherosclerotic steno-occlusive disease (ASOD) was found to have no benefit compared with medical treatment. However, there is also criticism that with sufficiently long-term follow-up, a crossover might emerge demonstrating the advantages of surgery. Therefore, we examined the long-term outcome of cerebral revascularization performed on patients with carefully selected ASOD at our center. Patients undergoing bypass surgery for non-moyamoya ischemic disease were retrospectively identified. The inclusion criteria were symptomatic ASOD with hemodynamic insufficiency, follow-up of more than 5 years, and stroke or surgical complications during follow-up. The clinical course and radiological findings were investigated. Poor outcomes were predicted using machine learning (ML) models, and Shapley additive explanation (SHAP) values and feature importance of each model were analyzed. A total of 109 patients were included from 2007 to 2018. The 30-day risk of any stroke or death was 6.4% (7/109). The risk of ipsilateral ischemic stroke during median follow-up of 116 months was 7.3% (8/109). The SHAP values showed that previously and empirically known stroke risk factors exert a relatively consistent effect on the prediction of models. The number of lesions with stenosis > 50% (odds ratio [OR] 5.77), age (OR 1.13), and coronary artery disease (OR 5.73) were consistent risk factors for poor outcome. We demonstrated an acceptable long-term outcome of cerebral revascularization surgery for patients with hemodynamically insufficient and symptomatic ASOD. Multicenter studies are encouraged to predict poor outcomes and suitable patients with large numbers of quantitative and qualitative data.

Keywords: Atherosclerosis; Bypass; Cerebral revascularization; Ischemic stroke; Machine learning; Occlusion; Stenosis.

PubMed Disclaimer

References

    1. Alexander MJ, Zauner A, Gupta R et al (2021) The WOVEN trial: Wingspan one-year vascular events and neurologic outcomes. J NeuroInterventional Surg 13(4):307–310
    1. Alvi MA, Rinaldo L, Kerezoudis P, Rangel-Castilla L, Bydon M, Cloft H, Lanzino G (2019) Contemporary trends in extracranial-intracranial bypass utilization: analysis of data from 2008 to 2016. J Neurosurg 1–9
    1. Amarenco P, Benavente O, Goldstein LB et al (2009) Results of the Stroke Prevention by Aggressive reduction in cholesterol levels (SPARCL) trial by stroke subtypes. Stroke 40(4):1405–1409 - PubMed
    1. Amin-Hanjani S, Butler WE, Ogilvy CS, Carter BS, Barker FG (2005) Extracranial-intracranial bypass in the treatment of occlusive cerebrovascular disease and intracranial aneurysms in the United States between 1992 and 2001: a population-based study. J Neurosurg 103(5):794–804 - PubMed
    1. Amin-Hanjani S, Barker FG, Charbel FT, Connolly ES, Morcos JJ, Thompson BG (2012) Extracranial-intracranial bypass for Stroke—Is this the end of the line or a bump in the Road? Neurosurgery 71(3):557–561 - PubMed

LinkOut - more resources