Development of a Novel Scoring Model to Estimate the Severity Grade of Mesenteric Artery Stenosis
Open accessAbstract
Objective: This study aimed to derive a new scoring model from estimating the severity grade of mesenteric artery stenosis. We sought to analyze the relationship between the new scoring model and the development, treatment, and mortality of chronic mesenteric ischemia (CMI). Methods: This retrospective study included 242 patients (128 (53%) women and 114 (47%) men) with suspected CMI from January 2011 to December 2020. A weighted sum six-point score (CSI-score; the celiac artery is abbreviated by “C”, superior mesenteric artery by “S”, and inferior mesenteric artery by “I”) based on the number of affected vessels and the extent and grade of the stenosis or occlusion of the involved visceral arteries was derived by maximizing the area under the ROC curve. The calculated CSI-score ranged from 0 to 22. The patients were divided according to the best cut-off point into low-score (CSI-score < 8) and high-score (CSI-score ≥ 8) groups. Results: The area under the receiver operating characteristic curve (AUC) of the CSI-score was 0.86 (95% CI, 0.82–0.91). The best cut-off point of “8” represented the highest value of Youden’s index (0.58) with a sensitivity of 87% and specificity of 72%. The cohort was divided according to the cut-off point into a low-score group (n = 100 patients, 41%) and high-score group (n = 142 patients, 59%) and according to the clinical presentation into a CMI group (n = 109 patients, 45%) and non-CMI group (n = 133 patients, 55%). The median CSI-score for all patients was 10 (range: 0 -22). High-scoring patients showed statistically significant higher rates of coronary artery disease (54% vs. 36%, p = 0.007), chronic renal insufficiency (50% vs. 30%, p = 0.002), and peripheral arterial disease (57% vs. 16%, p < 0.001). A total of 109 (45%) patients underwent invasive treatment of the visceral arteries and were more often in the high-score group (69% vs. 11%, p < 0.001). Of those, 79 (72%) patients underwent primary endovascular treatment, and 44 (40%) patients underwent primary open surgery or open conversion after endovascular treatment. Sixteen (7%) patients died during the follow-up, with a statistically significant difference between high- and low-scoring patients (9% vs. 0%, p = 0.008). The score stratification showed that the percentage of patients treated with endovascular and open surgical methods, the recurrence of the stenosis or failure of the endovascular treatment, the need for a bypass procedure, and the mortality rates significantly increased in the subgroups. The CSI-score demonstrated an excellent ability to discriminate between patients who needed treatment and those who did not, with an AUC of 0.87 (95% CI, 0.82–0.91). Additionally, the CSI-score’s ability to predict the patients’ mortality was moderate, with an AUC of 0.73 (95% CI, 0.62–0.83). Conclusions: The new scoring model can estimate the severity grade of the stenosis of the mesenteric arteries. Our study showed a strong association of the score with the presence of chronic mesenteric ischemia, the need for treatment, the need for open surgery, and mortality.
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CSI score has excellent ability to predict degree of mesenteric artery stenosis and strong association with need for treatment, open surgery, and mortality.
“The CSI score has shown an excellent ability to predict the degree of mesenteric artery stenosis and a strong association with the need for treatment, open surgery, and mortality [80].”
From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [80]
The Abstract and Results §3.4 report strong associations with the need for treatment, open surgery, and mortality, and excellent discrimination for whether patients needed treatment (AUC 0.87). The paper says the score can estimate stenosis severity, but it does not report excellent predictive performance for the degree of stenosis; the cited excellent-performance result concerns treatment need. (LLM, conf=0.86)
Experimental — accuracy not yet measuredHaving a 50-70% stenosis of multiple mesenteric arteries is associated with a higher risk of CMI.
“Moreover, different studies classifying stenosis grade as < 50%, 50 e 70%, and > 70% demonstrated that having a 50 e 70% stenosis of multiple mesenteric arteries was associated with a higher risk of CMI. 15,16”
From Editor's Choice - European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Diseases of the Mesenteric and Renal Arteries and Veins. (2025) · cites this paper as [16]
The Results (§3.1; page unavailable) show that two- and three-vessel stenosis was more common among CMI patients than non-CMI patients. The Discussion (§4; page unavailable) mentions 50–70% stenosis as a category used in another scoring model, but does not show that stenosis in that specific range across multiple arteries is associated with higher CMI risk. (LLM, conf=0.87)
Experimental — accuracy not yet measuredHigher CSI-score patients show statistically higher rates of coronary artery disease, chronic renal insufficiency, and peripheral artery disease.
“The study found higher-scoring patients to show statistically higher rates of coronary artery disease, chronic renal insufficiency, and peripheral artery disease [80].”
From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [80]
CSI-score stratification showed many high-score participants underwent endovascular, open surgical, or open conversion after endovascular treatment for chronic mesenteric ischemia.
“The score stratification showed that many high-score participants underwent endovascular, open surgical, or open conversion after endovascular treatment for chronic mesenteric ischemia [80].”
From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [80]
Patients with higher CSI scores demonstrated a significantly higher mortality rate.
“Patients with higher scores also demonstrated a significantly higher mortality rate [80].”
From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [80]
A recent retrospective study developed and tested a novel scoring model to estimate severity grade of mesenteric artery stenosis.
“A recent retrospective study developed and tested a novel scoring model to estimate the severity grade of mesenteric artery stenosis [80].”
From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [80]
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- Authors
- Omran, S., Konietschke, F., Mueller, V., de Bucourt, M., Frese, J. P., & Greiner, A.
- Affiliations
- Humboldt-Universität zu Berlin (DE)
- Department of Radiology, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany
- Corresponding author
- Omran, Safwan
- Venue
- Journal of Clinical Medicine
- Publisher
- MDPI AG
- Published
- 2022-12-14
- Volume
- 11
- Issue
- 24
- Pages
- 7420
- ISSN
- 2077-0383 (ISSN-L)
- PMC
- PMC9785168
- OpenAlex
- W4311791441
- Cited by
- 6
- References
- 42
- Citations by year
- 2025: 3 · 2024: 1 · 2023: 2
- FWCI
- 1.43
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Clinical Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Refubium (Universitätsbibliothek der Freien Universität Berlin) (submittedVersion, cc-by)
- Universitätsbibliothek der FU Berlin Hochschulschriftenstelle u. Dokumentenserver (cc-by)
- Funders
- German Research Foundation (DFG)
- Open Access Publication Funds of Charité—Universitätsmedizin Berlin
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Health Sciences › Medicine › Surgery › Vascular anomalies and interventions
- Keywords
- mesenteric artery stenosis, chronic mesenteric ischemia, scoring system, severity classification, visceral artery occlusion, celiac artery, superior mesenteric artery, inferior mesenteric artery, coronary artery disease, chronic renal insufficiency, peripheral arterial disease, mortality, revascularization, risk stratification, prognostic model
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