O-033 Clinical and angiographic outcome in patients with tandem occlusion thrombectomy: analysis from the ASSIST international registry
Notice bibliographique
Résumé
Introduction Tandem occlusions (TO) are a subtype of acute ischemic stroke (AIS) which involve an extracranial carotid lesion (i.e. severe carotid stenosis ≥ 70%) paired with the acute intracranial vessel occlusion. While the intracranial occlusion has a well-studied standard treatment approach with mechanical thrombectomy, the best practice for intervention of the extracranial carotid lesion, either through acute stenting or no stenting has not yet been determined. Our aim was to investigate the differences in clinical and procedural outcomes between the two approaches in patients presenting with AIS in the ASSIST registry. Materials and Methods The ASSIST registry (an international AIS mechanical thrombectomy prospective study) was utilized to identify the subgroup of AIS patients secondary to TO who received mechanical thrombectomy (MT). The TOs were then grouped by to MT+ acute carotid stenting (MT+CAS) vs non-stenting (MT+CAT). The demographics and clinical outcomes (90-day modified Rankin Scale score (mRS)) were compared between the TO group and no TO group, and between the MT+CAS vs MT+CAT. Multivariable analyses were performed to determine the independent predictors of clinical outcomes. Results A total of 183/1270 (14.4%) TOs were identified in ASSIST Registry. MT+CAS was performed in 83/183 (45.4%) subjects and 100/183 (54.6%) MT+CAT. There was no significant difference at baseline between the two groups in NIHSS, ASPECTS (Alberta Stroke Program Early CT Score), or vessel occluded. However, the acute stenting group were younger, lower premorbid mRS, and lower rate of atrial fibrillation. The rate of good clinical outcome (mRS 0–2) at 90-days was 70.9% in MT+CAS group vs 48.9% in MT+CAT group (p=0.001), with good clinical outcome being significantly associated with acute stenting (MT+CAS) group in multivariable analysis (OR= 2.3, CI95=1.02–5.1, adjusted for site clustering effects). There was no significant difference in mortality (4.8% MT+CAS VS 10.0% MT+CAT) or sICH (2.4% MT+CAS VS 3.0% MT+CAT) between the groups. Younger patients, lower NIHSS, and higher baseline ASPECTS scores were independent predictors of good clinical outcomes. Conclusions In AIS patients secondary to TOs treatment with thrombectomy and acute carotid stenting is associated with improved 90-day functional outcome without an increase in sICH when compared to no acute stenting approach. On going randomized trial are on the way to confirm these findings. Disclosures J. Olvany: None. Y. Ashouri: None. S. Miralbés: None. B. Naravetla: None. A. Spiotta: 1; C; Stryker (paid to institution), Penumbra (paid to institution), Microvention (paid to institution), Medtronic (paid to institution), RapidAI (paid to institution). 2; C; Stryker, Penumbra, Cerenovus, RapidAI, Terumo. 6; C; Participation on the Advisory Board Brain Aneurysm Foundation. C. Loehr: None. M. Martínez-Galdámez: None. R. McTaggart: None. L. Defreyne: None. P. Vega: None. P. Jenkins: 5; C; Stryker. D. Liebeskind: 2; C; Imaging core lab consulting for: Stryker, Cerenovus, Genentech, Medtronic, Rapid Medical, Vesalio. R. Gupta: 1; C; Assist Registry (PI, Stryker), RECCLAIM II Study (PI, Zoll). 2; C; Medtronic (ELEVATE Study), Penumbra (MIND Trial), Cerenovus (Membrane Study). 4; C; Vesalio, Rapid Medical. M. Möhlenbruch: 1; C; Stryker (paid to institution), Acandis, Balt, Medtronic, Microvention, Phenox. 6; C; Balt (Honoraria), Medtronic (Honoraria), Stryker (Honoraria, paid to institution). O. Zaidat: 1; C; Stryker (paid to institution), Penumbra (paid to institution), Cerenovus (paid to institution), Genentech (paid to institution), Microvention (paid to institution), Medtronic (paid to institution), Chiesi (paid to institution). 2; C; Stryker, Cerenovus, Penumbra, Medtronic.
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 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,003 |
| 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 | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 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 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 ».