E-045 Second line thrombectomy technique following an unsuccessful first pass thrombectomy for anterior circulation large vessel occlusion stroke: to switch or not to switch?
Notice bibliographique
Résumé
Introduction Despite comparable outcomes for different frontline techniques in mechanical thrombectomy (MT) for acute ischemic stroke (AIS), there are sparse data regarding if and when to switch techniques if the first-pass MT is unsuccessful. We investigated the converting from one MT technique to another on the second MT attempt for AIS among patients with anterior circulation large vessel occlusion (LVO). Methods This was a retrospective observational study using data from the large multicenter international ‘anonymous’. Data from 29 stroke centers for 10,229 patients between January 2010 and December 2022 was investigated. The primary outcome measure was successful recanalization defined as a modified Thrombolysis in Cerebral Ischemia score ≥2b. 90-day modified Rankin score (mRS) 0–2, mortality and symptomatic hemorrhage were used as secondary outcomes. Clinical and technical outcomes after the second MT attempt were compared between those with or without technique conversion. Results 1,797 patients with unsuccessful first-pass MT were included in this analysis. Converting to alternative techniques following an unsuccessful first-pass MT was more likely to be associated with successful recanalization at the second attempt (adjusted odds ratio 2.30, 95% CI: 1.37–3.86, P = 0.002) and 90-day good clinical outcome (adjusted odds ratio 2.10, 95% CI: 1.15–3.85, P = 0.02) after multivariate adjustment. Conclusions This study demonstrates better clinical and technical outcomes with the conversion of the MT technique for the second attempt in AIS patients with anterior circulation LVO and an unsuccessful first-pass MT. Disclosures H. Matsukawa: 2; C; B. Braun. 3; C; Daiichi-Sankyo, Stryker. K. Uchida: 3; C; Daiichi-Sankyo, Bristol-Myers Squibb, Stryker, Medtronic. A. Alawieh: None. C. Matouk: 1; C; Contact PI for NIH Grant R21NS128641. . 2; C; Stryker, Medtronic, Microvention, Penumbra, and Silk Road Medical. 3; C; Speaker for Penumbra and Silk Road Medical. S. Al Kasab: None. M. Sowlat: None. S. Elawady: None. R. Abo Kasem: None. J. Isidor: None. I. Maier: 3; C; speakers honoraria from Pfizer and Bristol-Myers Squibb. P. Jabbour: None. J. Kim: None. S. Quintero Wolfe: None. A. Rai: None. R. M 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, RMS has an unrestricted research grant from Medtronic and Balt and has consulting and teaching agreements with Penumbra, Abbott, Medtronic, Balt, InNeuroCo, Cerenovus, Naglreiter, Tonbridge, Von Medic. 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; Speaker fees: Stryker Neurovascular Inc., Medtronic Inc., Penumbra Inc., Acandis GmbH, Phenox GmbH, Siemens Healthineers AG. E. Samaniego: 2; C; consults for Medtronic, microvention, Rapid Medical. H. Cuellar: 2; C; Consultant for Medtronic and Microvention. B. Howard: None. D. Romano: 2; C; Penumbra, Balt, Microvention, Phenox. O. Tanweer: 1; C; Educational/Research Grants: Q’apel Inc, Steinberg Foundation. 2; C; Consulting Agreements: Viz.AI, Inc., Penumbra, Inc, Balt, Inc, Stryker Inc, Imperative Inc. J. Mascitelli: None. I. Fragata: None. J. Osbun: None. R. Crosa: None. M. S. Park: 2; C; Consultant for Medtronic. M. R. Levitt: 1; C; Unrestricted educational grants from Medtronic and Stryker;. 2; C; consulting agreement with Medtronic, Aeaean Advisers and Metis Innovative. 6; C; equity interest in Proprio, Stroke Diagnostics, Apertur, Stereotaxis, Fluid Biomed, and Hyperion Surgical; editorial board of Journal of NeuroInterventional Surgery; Data safety monitoring board of Ar. W. Brinjikji: 2; C; He receives consulting fees from Medtronic, Stryker, Imperative Care, Microvention, MIVI Neurovascular, Cerenovus, Asahi, and Balt. 6; C; Holds equity in Nested Knowledge, Superior Medical Editors, Piraeus Medical, Sonoris Medical, and MIVI Neurovascular. He receives royalties from Medtronic and Balloon Guide Catheter Technology, He serves in a leadership or fiduciary role for MIVI Neurovascular, Marblehead Medical LLC, Interventional Neuroradiology (Editor in Chief), Piraeus Medical, and WFITN. M. Moss: None. T. Dumont: None. R. Williamson Jr: 2; C; Consultant for Medtronic, Stryker, and Synaptive Medical. P. Navia: 2; C; Consultant for Penumbra, Medtronic, Stryker, Cerenovus and Balt. P. Kan: 1; C; Grants from the NIH (1U18EB029353–01) and unrestricted educational grants from Medtronic and Siemens. Consultant for Imperative Care and Stryker Neurovascular. 4; C; Stock ownership in Vena Medical. R. De Leacy: 1; C; PI for Imperative Trial; Research grants from Siemens Healthineers and Kaneka medical. 2; C; Consultant for Cerenovus, Stryker Neurovascular and Sim & Cure. 6; C; Minor equity interest Vastrax, Borvo medical, Synchron, Endostream, Von Vascular, Radical catheters and Precision Recovery Inc. S. Chowdhry: 2; C; Consultant and proctor for Medtronic and Microvention. M. Ezzeldin: 2; C; Consultant for Viz.ai and Imperative care. 4; C; Investments in Galaxy Therapeutics. S. Yoshimura: 6; C; lecture fee from Stryker, Medtronic, Johnson & Johnson, Kaneka Medics. A. Spiotta: 2; C; Consultant for Penumbra, Terumo, RapidAI, Cerenovus.
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 | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 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 ».