Abstract T P21: Complex Internal Carotid Artery T Occlusion By Computed Tomographic Angiography Is A Very Malignant Subtype With Massive Infarcts And Poor Outcomes Despite Revascularization Treatment
Bibliographic record
Abstract
Background: ICA T/L occlusions appear to have a particular poor prognosis due to low recanalization with intravenous tissue plasminogen activator alone. What is not known however is whether all ICA T/L occlusions remain as good candidates for endovascular treatment. We divided ICA T/L occlusions into distinct types according to Willisian collaterals and compared infarct core volumes and clinical outcomes in the two groups as well as other anterior circulation occlusion sites. Methods: We enrolled patients with acute ischemic stroke in anterior circulation whose CT angiography showed major intracranial artery occlusion. Patients were included if their MRI was taken just after CT scan and within 6 hours from onset. We classified patients into Complex ICA T, Simple ICA T/L, MCA M1, MCA M2, and extracranial to intracranial tandem groups. Among patients with ICA T/L occlusion, patients were classified into simple ICA T/L occlusion group if ACA A2 and PCA P2 segments are patent whereas those into complex ICA T group if A2, P2 or their distal branches were occluded, or contralateral occlusion was seen in ICA or contralesional A1 absent or hypoplastic. Other occlusion types were excluded in this study. Results: Table shows comparisons among groups. Age, sex and vascular risk factors did not differ among groups. Initial NIHSS score was different among groups. Pretreatment infarct core volume with ADC value threshold of 600 x 10-5 mm2/s was significantly different according to cerebral artery occlusion types. Clinical outcome significantly differed among groups regarding NIHSS score at discharge, frequency of good outcome (mRS 0-2 at 3 months), and frequency of 3-month mortality. Conclusion: We describe a subtype of carotid occlusions we have named as complex ICA T occlusions in which Willisian collateral flow is limited. This group is associated with very large infarct core volumes and poor 3-month outcomes despite acute revascularization treatment.
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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 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 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".