Abstract W P9: Recanalization in Wake-up Strokes
Bibliographic record
Abstract
INTRODUCTION: Current treatments for acute ischemic stroke are approved based on time of onset, providing a dilemma for stroke patients with unknown onset time. About 25% of patients present as wake-up strokes (WUS). Our aim was to identify characteristics associated with the clinical outcomes of WUS patients receiving acute revascularization therapies. METHODS: We retrospectively reviewed medical records of consecutive patients with ischemic stroke who received treatment at a large academic medical center from 1994-2014. We identified patients with symptoms upon awakening and those with indefinite time of onset presenting within 24 hours of last known normal time. Demographics, NIHSS, diffusion-weighted imaging-based Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS), treatment, and modified Rankin Scale (mRS) at 90-day follow-up were obtained. A good outcome was defined as 90-day mRS 0-2. RESULTS: Patients with unknown stroke onset time comprised 25.6% (90/351) of acute strokes treated in our series. Seventy-two were WUS, and 18 were indefinite time of onset not upon awakening. Median age was 70.5 (range 2-92), median NIHSS 13 (range 2-27), and median DWI-ASPECTS 8 (range 1-10). Large vessel occlusions were as follows: 39 M1 middle cerebral artery (MCA), 16 M2 MCA, 9 intracranial internal carotid artery (ICA), 8 basilar artery, 6 extracranial ICA, 2 M3 MCA, 2 distal MCA, 1 A2 anterior cerebral artery, 1 posterior cerebral artery, and 1 vertebral artery. Five cases did not have an occlusion. Forty-six were treated with thrombectomy, 11 with IV thrombolysis, 14 IA thrombolysis, 10 IA thrombolysis + thrombectomy, 3 IV + IA thrombolysis, 5 IV thrombolysis + thrombectomy, and 1 IV + IA thrombolysis + thrombectomy. Sixty-one patients had MRI on initial evaluation, and 51 (77%) had DWI-ASPECTS≥7. Of those, 16 (31.4%) had a good outcome at follow-up. Only 1 patient with DWI-ASPECTS<7 had good outcome, and 14/33 patients with DWI-ASPECTS≥7 had good outcome (p=0.04). Lower age (65 vs 74, p=0.03) was a predictor of good outcome at follow-up. CONCLUSIONS: Patients with anterior circulation strokes with unknown onset time and DWI-ASPECTS≥7 have potential for good outcome with acute treatment.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".