TIA and Minor Stroke Patients with Intracranial Occlusions in Both Proximal and Distal Vessels Are Most at Risk for Symptom Progression
Notice bibliographique
Résumé
Patients affected by TIA and minor stroke are at a high risk of recurrent events, symptom progression, and disability, especially if an intracranial occlusion is documented on a CT-angiogram (CTA) [1,2]. Despite a risk of poor outcome, these patients are often excluded from thrombolysis treatment because of mild or improving symptoms [3]. Recurrent events are phenomenologically either distinct recurrent strokes or symptomatic progression of the presenting event [4]. Unlike in major stroke, where proximal occlusion is an independent predictor [5], it remains unclear whether the exact site of vessel occlusion influences outcome in TIA and minor stroke patients [6]. Our aim was to explore the relationship between the location of intracranial occlusion and stroke progression in this population.The CATCH study [2] prospectively enrolled consecutive patients with minor stroke (NIHSS <4) and high-risk TIA (motor or speech impairment ≥5 min). Patients were excluded if they had pre-morbid mRS >1 or were treated with thrombolysis for this event. All patients had a brain CT and CTA of neck and circle of Willis within 24 h of symptom onset. A neuroradiologist identified the site of vessel occlusion. Stroke progression was defined as clinical worsening referable to the same arterial territory as the baseline symptoms without any imaging evidence of a new infarct separate from the baseline imaging [4]. Experienced stroke neurologists assessed the outcomes within 24 h of the index event. The relationship between vessel occlusion site and stroke progression was explored. If a patient had more than one intracranial occlusion, the most proximal site was used for analysis. Fisher's exact test was used to compare proportions, and interpreted with a Bonferroni correction for multiple comparisons. For each individual comparison, patients with other sites of intracranial occlusion were removed from the analysis.510 patients were enrolled. Intracranial occlusion was observed in 10% (52/510) of patients. Overall, stroke progression occurred in 4% (19/510) and was more likely to occur in the presence of an intracranial occlusion (RR 9.6, 95% CI 4-22). Sites of occlusion were as follows: intracranial internal carotid artery (ICA) 12/52 (23%), middle cerebral artery (MCA) 31/52 (60%; MCA-M1 7/52; MCA-M2 15/52; MCA-M3 9/52), posterior cerebral artery (PCA) 5/52 (10%; PCA-P1 3/52, PCA-P2 2/52), and basilar artery (BA) 2/52 (4%). Detailed sites of occlusion and progression rates are shown in table 1. Our analysis was limited due to the small number of patients in each group, but neurological worsening was seen in patients with both proximal and distal vessel occlusions.In this retrospective sub-study of the CATCH study [2,] we did not find any clear pattern in the site of vessel occlusion and risk of stroke progression. This finding leads us to suggest that studies using intracranial occlusion as an entry criterion in a TIA and minor stroke population should not exclude patients based simply on occlusion location. Finally, this study did not allow us to determine the mechanism explaining neurological deterioration, although we suspect that hemodynamic fluctuations [7] or support by the collateral circulation play a determinant role. Future studies could further analyze the relationship between site of occlusion, collateral circulation, and symptom progression.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».