LB-004 Intravenous alteplase has different effects on the efficacy of aspiration and stent retriever thrombectomy: analysis of the COMPASS trial
Notice bibliographique
Résumé
Background There is conflicting evidence on the utility of intravenous (IV) Alteplase in patients with emergent large vessel occlusion treated with mechanical thrombectomy (MT). The goal of this study was to examine whether there were differences in procedural and technical outcomes of MT depending on whether patients received IV Alteplase prior to intervention using the COMPASS dataset. Methods This was a post hoc analysis of the COMPASS: A trial of aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion. We compared clinical, procedural and angiographic outcomes of patients with and without prior IV Alteplase administration. In order to compare outcomes in patients treated with MT according to the use of IV Altepase, only patients presenting to the emergency department (ED) of the first hospital of arrival within 4 hours of stroke symptom onset or last known normal were included in our analysis. Results Of the 270 patients included in the COMPASS trial, 235 (87%) arrived to the ED within the first 4 hours of stroke symptom onset and were eligible for the post-hoc analysis. (115 patients in the aspiration first and 120 in the SR first groups, respectively).Atrial fibrillation was more frequently seen in the MT only when compared to the combined group (65.5% vs 38.6%, respectively, P<0.001). Other vascular risk factors, age, NIHSS severity, and the distribution of occlusion sites showed no statistically significant difference. On univariate analysis, administration of IV Alteplase prior to MT was found to be significantly associated with favorable outcomes (modified Rankin scale [mRS] 0–2 at 3 months; 55.6% vs 40% in the MT only group, P=0.037). However, on multivariate analysis only baseline (pre-stroke) mRS, admission NIHSS score and age were identified as independent predictors of favorable outcomes at 3 months. We found higher final TICI 2b/3 rates in patients without the use of Alteplase prior to the aspiration first approach (100% vs 87.9% in IV Altepase + aspiration first MT, P=0.03). In the SR first group, final TICI 2b/3 rates were identical in patients with and without IV Alteplase administration (87.5% and 87.5%, P=1.0). Conclusions Prior administration of IV Alteplase is not associated with improved procedural or clinical outcomes in patients with anterior circulation ELVO treated with MT. Alteplase may adversely affect the efficacy of aspiration first approach, but does not seem to influence the stent retriever first approach to MT. Disclosures M. Mokin: 1; C; NIH R21NS109575. 2; C; Cerenovus, Medtronic. 4; C; Brain Q, Endostream Serenity medical, Synchron. M. Waqas: None. J. Fifi: 2; C; Stryker, Penumbra, Microvention. 4; C; Cerebrotech, The Stroke Project. R. De Leacy: 2; C; Penumbra, Cerenovus, Siemens, Imperative Care. 4; C; Synchron, Endostream, Q’Apel. D. Fiorella: 2; C; Balt USA, Penumbra, Cerenovus, Stryker, Genentech, Shape Memory Medical, Marbelhead, Medtronic, MENTICE, Neuorogami, RAPID AI, Rapid medical, Phenox. E. Levy: 2; C; Penumbra, NextGen Biologics, Rapid Medical, Cognition Medical, Three Rivers Medical, Stryker, MedX, Endostream Medical. K. Snyder: 2; C; Penumbra, Canon Medical Systems, Medtronic, Jacobs Institute, Neurovascular Diagnostics. R. Hanel: 2; C; Penumbra, Endostream, Cerebrotech, Synchron, InNeuroCo, Medtronic, Microvention, Stryker, Cerenovus; Elum, Three Rivers. K. Woodward: None. I. Chaudry: 2; C; Medtronic, Microvention, Penumbra. 4; C; Cerenovus, Serenity Medical, Cerebrotech, Three Rivers Medical, Q’apel. A. Rai: 2; C; Penumbra, Microvention, Stryker. D. Frei: 2; C; Penumbra, Cerenovus, Stryker, Genentech, Shape Memory Medical, Siemens. J. Delgado Almandoz: 2; C; Penumbra, Medtronic. M. Kelly: 2; C; Penumbra, Medtronic, Endostream. A. Arthur: 2; C; Cerenovus, Medtronic, Microvention, Penumbra, Scientia, Siemens, Stryker. 4; C; Bendit, Cerebrotech, Endostream, Magneto, Marblehead, Neurogami, Serenity, Synchron, Triad, Vascular Simulations. B. Baxter: 2; C; Penumbra , Medtronic, Stryker, Cerenovus, Viz.ai, 880 medical, Route 92, Artio Medical. J. English: 2; C; Penumbra, Medtronic, Stryker, Route 92 Medical. I. Linfante: 2; C; Penumbra, Medtronic, Stryker, Microvention, InNeuroCo, Three Rivers. K. Fargen: None. A. Turk: 2; C; Cardinal consulting, Cerenovus, Corindus, Medtronic, Siemens, 880 medical. 4; C; Cerebrotech, Endostream. Imperative care, Three rivers medical, Vastrax, Shape memory, Synchron, Serenity medical, Blink TBI, Echovate, RIST, Apama, Q’Apel, VizAi, Early bird medical, Rapid medical, S. J. Mocco: 2; C; Imperative Care, Cerebrotech, VIseon, Endostream, Vastrax, RIST, Synchron, Viz.ai, Perflow and CVAid. 4; C; Cerebrotech, Imperative Care, Endostream, Viseon, BlinkTBI, Serenity, Cardinal Consulting, NTI, RIST, Viz.ai, Synchron. A. Siddiqui: 2; C; Amnis Therapeutics, Apellis Pharmaceuticals, Inc., Boston Scientific, Canon Medical Systems USA, Inc., Cardinal Health 200, LLC, Cerebrotech Medical Systems, Inc., Cerenovus, Cerevatech Medical, Inc.,. 4; C; Adona Medical, Inc., Amnis Therapeutics, Bend IT Technologies, Ltd., BlinkTBI, Inc, Buffalo Technology Partners, Inc., Cardinal Consultants, LLC, Cerebrotech Medical Systems, Inc, Cerevatech Medical.
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 machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,006 | 0,007 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,003 | 0,005 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,001 |
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 source (Gemma direct ou Codex distillé), 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 ».