E-063 Number of passes in mechanical thrombectomy matters in patients with large vessel occlusion presenting with low aspects score
Notice bibliographique
Résumé
Introduction Real-world data showed that less than half of the acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) presenting with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS) (2–5) achieved favorable outcomes at 90 days after mechanical thrombectomy (MT). In this study, we aim to investigate the relationship between the number of MT passes at which successful recanalization is obtained and outcomes in LVO-related AIS patients with low ASPECTS. Methods This retrospective cohort study was performed on the data from 31 thrombectomy-capable centers between 2013 to 2022. Successful recanalization was defined as modified Thrombolysis in Cerebral Ischemia Score ≥ 2b. The primary outcome was a 90-day modified Rankin Scale (mRS) of 0–3. Secondary outcomes were symptomatic intracranial hemorrhage and intracranial hemorrhage within 24 hours and mortality at 90 days. Outcomes were compared among patients with unsuccessful recanalization, successful recanalization at first, second, third, and more than four passes. Results A total of 297 patients with a median age of 70 [IQR 59–78] years were included and 140 (47.1%) were female. In 239 (80.4%) patients, successful recanalization was achieved: 88 patients (29.6%) with 1 pass, 59 patients (19.9%) with 2 passes, 35 (11.8%) patients with 3 passes (11.8%), and 57 patients (19.2%) with more than 4 passes. Compared to unsuccessful recanalization, successful recanalization at first pass (adjusted OR 5.25, 95% CI 1.78 - 17.1), second passes (adjusted OR 5.20, 95% CI 1.68 - 17.6), and passes 4 (adjusted OR 4.90, 95% CI 1.68 - 17.6) was related to 90-day mRS 0–3. Recanalization status and MT attempt number were not related to secondary outcomes except for 90-day mortality. Compared to unsuccessful recanalization, successful recanalization at second and third passes were inversely related to 90-day mortality (adjusted OR 0.37, 95% CI 0.14 - 0.93; adjusted OR 0.33, 95% CI 0.11 - 0.95, respectively). Conclusion The present results indicated that successful recanalization was related to 90-day good outcome regardless the number of MT passes but the odds of achieving favorable outcome declined with each pass. Disclosures M. Sowlat: None. S. Samir Elawady: None. H. Matsukawa: 2; C; B. Braun. 6; C; Daiichi-Sankyo, Stryker. J. Isidor: None. C. Cunningham: None. R. Abo Kasem: None. A. Orscelik: None. I. Maier: 6; C; Pfizer, Bristol-Myers Squibb. P. Jabbour: None. J. Kim: None. S. Quintero Wolfe: None. A. Rai: None. R. M Starke: 1; C; NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, Department of Health Biomedical Research Grant (21K02AWD-007000) and by National Institute of Health (R01NS111119–01A1) and (UL1, Medtronic and Balt. 2; C; Penumbra, Abbott, Medtronic, Balt, InNeuroCo, Cerenovus, Naglreiter, Tonbridge, Von Medical, and Optimize Vascular. M. Psychogios: 1; C; 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, Stryker Neurovascular Inc., Phenox GmbH, Penumbra Inc. and Rapid Medical Inc., Sponsor-PI SPINNERS trial (Funded by a Siemens Healthineers AG Grant). 3; C; Stryker Neurovascular Inc., Medtronic Inc., Penumbra Inc., Acandis GmbH, Phenox GmbH, Siemens Healthineers AG. 6; C; Siemens Healthineers AG, Local PI for the ASSIST, EXCELLENT, TENSION, COATING, SURF and ESCAPE-NEXT trials. E. A Samaniego: 2; C; Medtronic, microvention, Rapid Medical. N. Goyal: None. S. Yoshimura: 6; C; Stryker, Medtronic, Johnson & Johnson, Kaneka Medics. H. Cuellar: 2; C; Medtronic and Microvention. J. A. Grossberg: 2; C; Cognition, Imperative Care. 6; C; Georgia Research Alliance, Emory Medical Care Foundation, Neurosurgery Catalyst. A. Alawieh: None. A. Alaraj: 2; C; Cerenovus. M. Ezzeldin: 2; C; Viz.ai and Imperative care. 4; C; Galaxy Therapeutics. D. G. Romano: 2; C; Penumbra, Balt, Microvention, Phenox. O. Tanweer: 1; C; Q’apel Inc, Steinberg Foundation. 2; C; Viz.AI, Inc., Penumbra, Inc, Balt, Inc, Stryker Inc, Imperative Inc. 6; C; Microvention Inc, Medtronic Inc. J. Mascitelli: None. I. Fragata: None. A. Polifka: None. F. Siddiqui: None. J. Osbun: None. R. Grandhi: 2; C; Balt Neurovascular, Cerenovus, Medtronic Neurovascular, Rapid Medical, and Stryker Neurovascular. R. Crosa: None. C. Matouk: 2; C; Stryker, Medtronic, Microvention, Penumbra, and Silk Road Medical. 3; C; Penumbra and Silk Road Medical. M. S. Park: 2; C; Medtronic. M. R. Levitt: 1; C; Medtronic and Stryker. 2; C; Medtronic, Aeaean Advisers and Metis Innovative. 6; C; Proprio, Stroke Diagnostics, Apertur, Stereotaxis, Fluid Biomed, and Hyperion Surgical, editorial board of Journal of NeuroInterventional Surgery; Data safety monitoring board of Arsenal Medical. W. Brinjikji: 2; C; 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. E. Daglioglu: None. R. Williamson Jr.: 2; C; Medtronic, Stryker, and Synaptive Medical. P. Navia: 2; C; Penumbra, Medtronic, Stryker, Cerenovus and Balt. P. Kan: 1; C; Grants from the NIH (1U18EB029353–01) and unrestricted educational grants from Medtronic and Siemens. 2; C; Imperative Care and Stryker Neurovascular. 4; C; Vena Medical. R. De Leacy: 1; C; Research grants from Siemens Healthineers and Kaneka medical. 2; C; Cerenovus, Stryker Neurovascular and Sim & Cure. 6; C; Minor equity interest Vastrax, Borvo medical, Synchron, Endostream, Von Vascular, Radical catheters and Precision Recovery Inc., PI for Imperative Trial. S. Chowdhry: 2; C; Medtronic, Microvention. D. J Altschul: 2; C; MicroVention, Stryker, and Cerenovus. A. M. Spiotta: 2; C; 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 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 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 | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 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 ».