E-028 The impact of time delays on endovascular reperfusion success in late window stroke patients
Notice bibliographique
Résumé
Introduction Delays have a negative impact on successful reperfusion with endovascular thrombectomy (EVT) in early-window strokes. Late window patients may be further disadvantaged due to their late presentation. We assessed the impact of delays on reperfusion success in late window stroke patients. Materials and Methods We pooled data from seven trials and registries in North America, Europe, and Korea, for anterior circulation stroke patients treated with EVT between 6 and 24 hours from onset. We explored the impact of delays across multiple time metrics, including onset (or last known well) to hospital arrival; hospital arrival to arterial puncture; and CT to arterial puncture. Our primary outcome was successful reperfusion, defined as a final thrombolysis in cerebral infarction (TICI) score of 2b-3. Univariable and multivariable logistic regression analyses were performed to assess the association between each of the time metrics and successful reperfusion; adjusting for age, sex, occlusion site, NIHSS score, and wake-up stroke status. Results We included 608 patients. The median age was 70 years (IQR: 21), 307 [50.2%] were females, and 311 (53.2%) had wake-up strokes. All patients had CT and CT angiography imaging, and 379 patients (62.3%) also underwent perfusion imaging. Successful reperfusion was achieved in 494 (81.2%) patients. Patients with successful reperfusion were more likely to have had wake-up strokes (55.7% versus 42.7%, p=0.02) and lower NIHSS scores (median 15 [IQR 8] versus 17 [10], p=0.02) compared to unsuccessful reperfusion patients. Successfully reperfused patients had a significantly shorter hospital arrival to arterial puncture time (90 minutes [60–150] versus 110 minutes [84.5–150], p=0.01) compared to unsuccessfully reperfused patients. The odds of successful reperfusion decreased by 6% for every one-hour delay in arrival to puncture (adjusted OR 0.94, 95% CI 0.89–0.99). The CT to puncture time was not different between the successful versus unsuccessful reperfusion patients in univariable and multivariable analyses (65 minutes [39–111] versus 66 minutes [46–105], p=0.33). The onset (last known well) to hospital arrival was longer in the successful reperfusion patients (555 minutes [412–692] versus 436 minutes [362–639.5], p=0.01). This difference, however, did not persist in the multivariable analysis (adjusted OR 1.07 for every one-hour delay, 95% CI 0.93–1.23). Conclusion Faster hospital arrival to arterial puncture time is associated with a higher rate of successful reperfusion in late window stroke patients. Pre-hospital delays were not associated with subsequent reperfusion. Disclosures I. Alhabli: None. F. Benali: None. S. Murphy: None. D. Toni: None. P. Michel: None. M. Hill: None. D. Herlihy: None. I. Casetta: None. S. Power: None. V. Saia: None. A. Hegarty: None. G. Pracucci: None. A. Demchuk: None. S. Mangiafico: None. K. Boyle: None. M. Goyal: None. S. Nannoni: None. E. Fainardi: None. J. Thornton: None. B. Kim: None. B. Menon: None. M. Almekhlafi: None. F. Bala: None.
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 | 0,004 | 0,008 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,003 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,019 | 0,002 |
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 ».