Abstract T P34: Poor Collateral Circulation Assessed By Multiphase Cta Predicts Malignant Mca Evolution After Reperfusion Therapies
Bibliographic record
Abstract
Background: Collateral circulation (CC) has been associated with recanalization, infarct volume, risk of haemorrhagic transformation and clinical outcome in patients undergoing acute reperfusion therapies. However, its relationship with the development to malignant MCA infarction (mMCAi) has not been evaluated. Our aim was determine the impact of collateral circulation using multiphase CTA (mCTA) on acute phase in the prediction of mMCAi. Methods: Consecutive acute stroke <4.5h patients that were evaluated for reperfusion therapies and with a M1-MCA or TICA occlusion by CTA were included. CC was evaluated on mCTA, CC evaluation was performed according to the University Calgary CC Scale; CC was also classified as poor (grades 0-3) or good (grades 4-5). The mMCAi was defined according to previously published clinical and radiological criteria. Recanalization was assessed with TCD at 24-hours and TICI score≥2a in endovascular treatment (ET) patients. Good outcome was defined as mRS 0-2 at 3months. Results: 82 patients were included. Mean age: 65.1 ±13.83 years, median baseline NIHSS 18(IQR 5.7), 67.9% M1 and 32.1% TICA occlusions, 53 patients received ET and 57 iv tPA, 15 patients develop a mMCAi. In the univariate analysis, patients with mMCAi had lower CC scores (2.29 Vs. 3.71 p=0.001), higher baseline NIHSS (19.86 Vs. 15.70 p=0.016), lower TIMI reperfusion scores (0 Vs. 2.79 p=00.5) and presence of TICA occlusion was more often compared with M1 occlusion (71% Vs. 11.9%, p=0.033) ET was associated with lower rate of mMCAi development as compared with only i.v. reperfusion treatment (9.4%Vs.29.6%, p=0.028). Furthermore, all patients with poor CC who did not recanalize developed mMCAi (6 Vs. 0, p=0.68) On the multivariate analysis adjusted to age, vessel occlusion, baseline NIHSS and recanalization, the presence of poor CC by mCTA was the only independent predictor of mMCAi (p=0.048 OR: 9.72, 95%IC: 1.387-92.53) Conclusion: CC assessment by mCTA independently predicts malignant MCA progression. In patients with persistent occlusion after reperfusion therapies, the presence of poor CC may help in the early malignant MCA detection and management.
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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 | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.005 | 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".