O-068 Carotid artery stenting versus balloon angioplasty for management of anterior circulation tandem large vessel occlusions: a multicenter study
Notice bibliographique
Résumé
Introduction The optimal treatment for tandem large vessel occlusions (TOs) is unclear. This study compared balloon angioplasty plus carotid artery stenting (CAS) versus balloon angioplasty (BA) alone for managing TOs. Methods This retrospective study analyzed data from the Stroke Thrombectomy and Aneurysm Registry. The primary outcome was the 90-day functional outcome. Secondary outcomes included mortality and degree of revascularization. Safety outcomes included periprocedural complications. Inverse propensity scoring and regression adjustment (IPSWR) addressed non-random treatment selection. To correct for multiple hypothesis testing, especially with significant post-hoc changes, the Sidak (1967) correction to p-values will be utilized and the Sidak-adjusted p (ps) will be reported. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were reported. Results The study included 244 TO patients, with 132 undergoing CAS and 112 undergoing BA. The CAS group had higher rates of successful reperfusion (95% vs 83.9% ORTUGA, p<0.001) but similar rates of good functional outcome and mortality compared to the BA group. IPSWR found no significant difference between CAS and BA for good functional outcome (ATE -0.13, 95% CI -0.29 to 0.02, p=0.08, ps=0.29), mortality (ATE 0.05, 95% CI -0.06 to 0.15, p=0.37, ps=0.87), or symptomatic ICH (ATE 0.04, 95% CI -0.05 to 0.13, p=0.40, ps=0.85). On Weighted regression, older age (aOR: 0.95, 95% CI 0.91–0.99; p=0.01, ps=0.15) and higher admission NIHSS (aOR: 0.93, 95% CI 0.87–0.99; p=0.02, ps=0.32) were associated with lower odds of functional independence. Intravenous thrombolysis was independently associated with higher odds of symptomatic Intracranial hemorrhage (sICH) (aOR: 6.62 [95% CI, 1.44 - 30.5]; p=0.02, ps=0.22), but not on its interaction analysis with CAS (aOR: 0.23 [95% CI, 0.03 - 1.89]; p=0.17, ps=0.95). Alberta Stroke Program Early Computed Tomography scores between 8–10 were associated with lower odds of sICH compared to 0–7 (aOR: 0.22 [95% CI, 0.07 - 0.69]; p=0.01, ps=0.14). Conclusion This study found CAS and BA to be comparably safe and effective when combined with mechanical thrombectomy for TOs, but CAS tied to higher sICH from lower ASPECTS and IVT use, leaving uncertainty over the best approach. A limitation of our study is the statistical analysis when accounting for comparisons, mitigated by employing the Sidak-class method, revealing nonsignificant differences and emphasizing comparable functional outcomes between CAS and BA procedures. Nevertheless, further randomized trials are warranted to definitively determine the optimal endovascular approach. Disclosures M. Essibayi: None. E. Almallouhi: None. M. Anadani: None. R. Medeiros: None. S. Yaghi: 2; C; Nonfunded research collaboration with Medtronic. I. Maier: 6; C; Speakers honoraria from Pfizer and Bristol- Myers Squibb. P. Jabbour: None. J. Kim: None. J. Kim: None. S. Wolfe: None. A. Rai: None. R. Starke: 1; C; RMS research is supported by the NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, Department of Health Biomedical Research Grant (21K02AWD-007000) and by National Institute of H. 2; C; Penumbra, Abbott, Medtronic, Balt, InNeuroCo, Cerenovus, Naglreiter, Tonbridge, Von Medical, and Optimize Vascular. M. Psychogios: 1; C; Grants from the Swiss National Science Foundation (SNF) for the DISTAL trial (33IC30_198783) and TECNO trial (32003B_204977), Grant from Bangerter-Rhyner Stiftung for the DISTAL trial. Unrestricted Gr. 3; C; Stryker Neurovascular Inc., Medtronic Inc., Penumbra Inc., Acandis GmbH, Phenox GmbH, Siemens Healthineers AG. A. Shaban: None. A. Arthur: 1; C; Balt, Medtronic, Microvention, Penumbra and Siemens. 2; C; Arsenal, Balt, Johnson and Johnson, Medtronic, Microvention, Penumbra, Perfuze, Scientia, Siemens, Stryker. S. Yoshimura: 2; C; Stryker, Medtronic, Johnson & Johnson, Kaneka Medics. B. Howard: None. A. Alawieh: None. I. Fragata: None. H. Cuellar: 2; C; Medtronic, Penumbra and Microvention. A. Polifka: 2; C; Depuy Synthes and Stryker. J. Mascitelli: None. J. Osbun: None. C. Matouk: 1; C; R21NS128641. 2; C; Stryker, Medtronic, Microvention, Penumbra, and Silk Road Medical. M. Park: 2; C; Medtronic. M. Levitt: 1; C; Unrestricted educational grants from Medtronic and Stryker. 2; C; consulting agreement with Medtronic, Aeaean Advisers and Metis Innovative; equity interest in Proprio, Cerebrotech, Apertur, Stereotaxis, Fluid Biomed, and Hyperion Surgical. T. Dumont: None. R. Williamson: 2; C; Medtronic, Stryker, and Synaptive Medical. D. Altschul: 1; C; Grant from Bee foundation. 2; C; Microvention. A. Spiotta: 1; C; Research support from Penumbra, Stryker, Medtronic, RapidAI, Avail. 2; C; Penumbra, Stryker, Terumo, and RapidAI. Equity Avail. S. Al Kasab: 1; C; Grant from Stryker for RESCUE-ICAS registry.
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 | 0,005 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 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 ».