Abstract W P38: Collateral Circulation Status Correlates With Aspects Decay During Inter-facility Transfer After Anterior Acute Ischemic Stroke Patients
Bibliographic record
Abstract
Introduction: The collateral circulation plays an important role in the dynamic process of cerebral ischemia. The aim of this study is to determine if collateral status correlates with the early ischemic changes measured by the rate of Alberta Stroke Program Early CT Scores (ASPECTS) decay in emergently transferred acute ischemic stroke patients with anterior large vessel conclusions. Material and methods: We retrospectively analyzed the data of patients referred to our comprehensive stroke center from 7 outside hospitals between January 15, 2006 and January 15, 2014. Collateral status was assessed using an initial CT angiography obtained before treatment, and graded as "Good" (the entire medial cerebral artery reconstitutes with contrast) or "Poor" (partial or no reconstitution of the distal medial cerebral artery), by two independent reviewers (CA and WD). ASPECTS decay was calculated in the following ways: 1. Absolute ASPECTS decay: (A1-A2)/T, 2. Relative ASPECTS decay: [(A1-A2)/A1]/T 3. Net ASPECTS difference: (A1-A2) and 4. Relative ASPECTS difference: (A1-A2)/A1; where A1= ASPECTS 1st CT, A2= ASPECTS 2nd CT, T= hours between 2 CT scans. Results: After reviewing 701 medical records from transferred patients, 51 patients with mean age 65±3 yrs and median initial NIHSS of 17 (IQR 14-21) were selected. In the multivariate analysis, good collateral status was independently associated with lower rates of ASPECTS decay measured by the relative rate of ASPECTS decay (0.04+/-0.01 score/h; p<0.05), the net ASPECTS difference (1.10+/-0.17 score/h, p<0.05) and the relative ASPECTS difference (0.12+/-0.02 score, p<0.05). The relative ASPECTS difference was most strongly associated with collateral status, and an independent predictor of good outcome (p=0.047) and final infarct volume (p=0.001) after controlling for age and NIHSS in a multivariate analysis. Conclusions: Good collateral circulation status is associated with lower rates of ASPECTS decay in transferred patients, which also tend to have smaller final infarct volumes and better clinical outcome after 3 months. The analysis of the collateral circulation gives us a better understanding of the pathophysiology in acute ischemic stroke.
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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 | 0.001 | 0.003 |
| 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) | 0.002 | 0.000 |
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".