Risk stratification of acute symptomatic anterior circulation intracranial atherosclerotic stenosis using an ABCD³-I-informed clinical-imaging score: an exploratory study.

Authors

Zhuli Peng, Xibu Zhou, Zini Xiong, Haolin Liu, Xiaolong Chen, Xiaoxin Bai

Published in

Frontiers in neurology. Volume 17. Pages 1897338. Epub Sep 11, 2026.

Abstract

Acute symptomatic anterior circulation intracranial atherosclerotic stenosis (ICAS; ≥70%) carries substantial risks of early neurological deterioration (END) and disability. We developed an ABCD³-I-informed clinical-imaging score incorporating pre-baseline progressive stroke, responsible-vessel stenosis, and diffusion-weighted imaging (DWI) infarct pattern for acute risk screening.
We retrospectively enrolled 133 consecutive patients (103 men, 30 women; mean age: 64.62 ± 10.56 years) with acute symptomatic anterior circulation ICAS (≥70% stenosis; onset ≤7 days) at a single center (January 2024-June 2025). The score (0-13) categorized patients as high risk (≥8; n = 102) or non-high risk (n = 31). The primary outcome was the ordinal 90-day modified Rankin Scale (mRS) score; the secondary outcomes were mRS scores ≥3 and END. Adjusted regression and receiver operating characteristic (ROC) analyses were performed, and discrimination was compared with the original ABCD³-I.
The high-risk group had higher admission National Institutes of Health Stroke Scale (NIHSS) scores (median 2.0 vs. 0.0; p < 0.001). The ABCD³-I-informed clinical-imaging score discriminated END (area under the curve [AUC] 0.833, 95% CI 0.760-0.906; 50.0% vs. 19.4%, p = 0.005). The unadjusted 90-day mRS score distribution was worse in the high-risk group (z = -2.405, p = 0.016), but the ABCD³-I-informed clinical-imaging score was not significant after adjustment for admission NIHSS in the proportional-odds model (adjusted common OR 1.05 per point, 95% CI 0.88-1.26; p = 0.573). The dichotomized disability rate (mRS ≥ 3: 18.6% vs. 9.7%) did not differ significantly (p = 0.285; adjusted OR 1.11, 95% CI 0.86-1.44). For 90-day disability, the AUC was 0.662 (95% CI 0.540-0.783; p = 0.017). At the prespecified ≥8-point threshold, 31 patients (23.3%) were classified as non-high-risk; the negative predictive value was 90.3% (95% CI 75.1-96.7%). Discrimination did not differ significantly from the original ABCD³-I score (ΔAUC 0.068, 95% CI - 0.063 to 0.196; DeLong p = 0.312).
The ABCD³-I-informed score may identify a non-high-risk subgroup and show strong END discrimination, but its association with a 90-day outcome was modest and NIHSS-dependent. It should complement, not replace, baseline neurological assessment and should not guide treatment selection; prospective multicenter validation is required.

PMID:
42798405
Bibliographic data and abstract were imported from PubMed on 26 Sep 2026.

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