Abstract 209: Intracranial Wall Irregularity and Recurrent Stroke: the SPS3 Trial
Bibliographic record
Abstract
Background and Purpose: Intracranial atherosclerosis is an important cause of ischemic stroke and even mild stenosis or subtle wall changes may be a marker for subsequent stroke risk. We tested whether any arterial wall irregularity was predictive of recurrent stroke in participants of the Secondary Prevention of Small Subcortical Strokes (SPS3) trial. Methods: SPS3 was a randomized trial investigating optimal blood pressure target and antiplatelet regimen in patients with recent, symptomatic, MRI-confirmed lacunar stroke patients. Magnetic resonance angiography (MRA) proximate to study entry was adequate and available for 2169 of 3020 study patients. Seven intracranial arteries (basilar [BA], vertebral [VA], internal carotid [ICA], and middle cerebral artery [MCA]) were assessed on time-of-flight MRA for wall irregularities including stenosis and changes of arterial diameter. Cox Proportional Hazards models adjusted for assigned treatments and clinical risk factors were used to estimate risk for recurrent stroke associated with any wall irregularity overall and in specific arteries. Results: Mean age of the 2169 patients was 63 yr with 63% male; hypertension, diabetes, and prior lacunar stroke were present in 75%, 36%, and 10%, respectively. Wall irregularities in ≥1 artery (325 one artery, 250 > 1 artery) were observed in 575 patients (27%). Recurrent stroke occurred in 195 patients during mean follow-up of 3.5 years (annualized rate 2.5% per patient-year). Patients with at least one wall irregularity had an increased risk of recurrent stroke (adjusted HR 1.4, 95% CI 1.0-1.9). There was no interaction between either randomized treatment arm (antiplatelet therapy or blood pressure control target) and wall irregularities. Irregularity by any individual artery (BA, n = 115, 14 strokes; VA, n = 150, 17 strokes; ICA, n = 268, 31 strokes; or MCA, n = 316, 37 strokes) was not predictive of recurrent stroke (each p >0.1). Conclusion: In this large well characterized cohort of lacunar stroke patients, any wall irregularity in at least one artery was associated with recurrent stroke independent of clinical risk factors and assigned treatment groups.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 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".