E-290 A comparison of thrombolysis with either tpa or tnk in large vessel occlusion patients undergoing transport to a comprehensive stroke centre for mechanical thrombectomy
Notice bibliographique
Résumé
Introduction Recent studies have demonstrated that patients with large vessel occlusion treated with TNK showed a higher rate of early recanalization as opposed to tPA. Our centre is the lone comprehensive stroke centre (CSC) in our province of 1.2 million people and the only institution offering mechanical thrombectomy (MT). We set out to compare patients sent to the CSC treated in the periphery with these two models of stroke management for completed MT and for rates of recanalization. Materials and Methods We performed a retrospective review of consecutive patients between January 1, 2022 and December 31, 2023 with anterior circulation large vessel occlusion (LVO) stroke at a peripheral institution that were transferred to the CSC with intention to receive MT. The rates of patients who did not receive MT was compared based on thrombolytic used. We compared baseline demographics and rate of MT completion between the two groups as well as reasons for not receiving MT. Parametric continuous data were compared by Student’s t-test and non-parametric continuous data were compared by Mann-Whitney U-test. Categorical data were compared by chi-squared test. Results 214 patients transferred from peripheral sites were included, 92 of which were treated with tPA and 122 were treated with TNK. Of the patients transferred, 64 (30%) did not receive thrombectomy upon arrival to the comprehensive stroke centre. In total, 27 tPA patients (29%) and 37 (30%) TNK patients did not receive thrombectomy (p=1). The mean age in the tPA population was 73 ± 11.8, and the mean age in the TNK population was 69 ± 16.7 (p=0.463). The number of female patients who received tPA was 10 (37%) and TNK was 19 (51%) (p=0.256). The number of left sided LVOs who received tPA and TNK was 15 (56%) and 19 (51%) (p=0.739), respectively. Mean ASPECT score for both populations was 8 (p=0.648). In the tPA population, reasons for not receiving thrombectomy include recanalization (12 (44%)), symptom improvement (7 (26%)), evolution of stroke (8 (29%)). In the TNK population, reasons for not receiving thrombectomy include recanalization (13 (35%)), symptom improvement (8 (21%)), evolution of stroke (15 (40%)), and anatomy (1 (3%)). There was no statistical difference in the reasons for not receiving thrombectomy between the populations (p=0.715). Conclusions Despite recent trial evidence suggesting superiority of TNK over tPA in terms of early recanalization of LVOs, we did not observe the same trend in real-world data at our CSC. Reasons for this could be numerous and require further data extraction. Additionally, our study provides ongoing evidence that patients treated in the periphery with thrombolysis should continue to be transferred to a CSC providing endovascular therapy given the high rates of MT provided. Disclosures B. Newton: None. A. Persad: None. E. Liu: None. G. Hunter: None. R. Cooley: None. S. Wasyliw: None. B. Graham: None. R. Whelan: None. S. Ahmed: None. L. Peeling: None. M. Kelly: 2; C; Medtronic Inc., Penumbra Inc., Cerenovus Inc. 4; C; Basecamp Vascular SAS, Radical Catheter Technologies, Inc., Endostream Medical, Ltd., Temple Therapeutics.
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 | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| 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) | 0,005 | 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 ».