Safety and efficacy of short-term tirofiban combined with dual antiplatelet therapy after flow diverter placement for intracranial aneurysms: a multicenter retrospective study and nomogram for thromboembolic event prediction

Figures

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  Figure 1. Lasso regression-based variable selection. (A) The trajectory of each variable coefficient as a function of log(λ). Each colored line represents the coefficient path of a variable during LASSO regularization. (B) The optimal value of the regularization parameter λ was determined by 10-fold cross-validation, where the red dots represent the mean binomial deviance and the error bars indicate standard deviations. The vertical dotted lines correspond to the λ values with minimum deviance and one standard error from the minimum, respectively.

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  Figure 2. Construction and validation of the nomogram for predicting thromboembolic events (TEEs) after flow diverter treatment in patients with intracranial aneurysms. (A) Nomogram developed to estimate the probability of thromboembolic events based on independent predictors identified by LASSO logistic regression. (B) Receiver operating characteristic (ROC) curve of the nomogram, showing an area under the curve (AUC) of 0.723 (95% CI: 0.606–0.840), indicating acceptable discriminative performance. (C) Calibration curve of the nomogram generated by bootstrap resampling, demonstrating good agreement between predicted and observed probabilities.

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  Figure 3. Decision curve analysis (DCA) of the nomogram for predicting TEEs after flow diverter treatment. The decision curve demonstrates the clinical net benefit of the nomogram at different threshold probabilities in both the training (blue line) and test (red line) cohorts. The gray line (“All”) represents the assumption that all patients would experience TEEs, whereas the black line (“None”) assumes that no patient would experience TEEs. The results indicate that the nomogram provides greater clinical benefit than the treat-all or treat-none strategies across a wide range of threshold probabilities.

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  Figure 4. Forest plot of independent predictors of thromboembolic events (TEEs) after flow diverter treatment in patients with intracranial aneurysms. Multivariate logistic regression analysis identified maximum aneurysm diameter and feeding artery diameter as independent predictors of TEEs. A larger aneurysm diameter was associated with an increased risk of thromboembolic events (OR = 1.153, 95% CI: 1.087–1.223, p < 0.0001), whereas a larger feeding artery diameter (≥ 3.5 mm) was a protective factor (OR = 0.442, 95% CI: 0.286–0.682, p = 0.0003).