E-074 Emergency Carotid Artery Stenting in Acute Ischemic Stroke
Bibliographic record
Abstract
Introduction/purpose Recanalization of occluded arteries is crucial for good functional outcome of acute stroke patients with large vessel occlusion. Endovascular treatment, particularly mechanical thrombectomy, plays an increasing role to achieve rapid recanalization. However, some patients with acute large vessel occlusion have additional extracranial cervical carotid artery occlusion or severe stenosis. Although these patients might undergo carotid stenting to achieve recanalization of intracranial occlusions, such stenting causes challenges in subsequent clinical management. The purpose of this study was to evaluate the safety and efficacy of endovascular recanalization treatment with emergency carotid artery stenting for acute stroke patients. Materials and methods We analyzed clinical and angiographic data of patients who underwent emergency cervical internal carotid artery (ICA) stenting in the setting of acute endovascular recanalization treatment in our institution between May 2005 and December 2012. Reperfusion was assessed according to the modified Thrombolysis in Cerebral Infarction (mTICI) score. Clinical outcome was evaluated at discharge and at 3 months after treatment by modified Rankin Scale (mRS). Results 23 patients were included in this cohort. The mean age was 63.3 years. The median NIHSS score on admission was 20 (range, 3–25). The median Alberta Stroke Program Early CT Score on diffusion-weighted imaging (ASPECTS-DWI) on admission was 7 (range, 2–10). 17 patients (73.9%) had ICA occlusion at the origin. 19 patients (82.6%) had intracranial tandem vessel occlusions. All patients successfully underwent carotid artery stenting and 15 patients (65.2%) underwent additional mechanical thrombectomy for intracranial vessels. After the procedure, 9 patients (39.1%) were mTICI grade >IIb. Haemorrhagic transformation with parenchymal hematoma occurred in 9 patients (39.1%) and 2 (8.7%) was symptomatic. At discharge and at 3-months follow-up, 6 patients (26.1%) had a favorable outcome (mRS0–2). The multiple logistic model yielded age (P = 0.018) and initial ASPECTS-DWI (P = 0.029) independently associated with a favorable outcome and additionally mechanical thrombectomy (P = 0.003) was associated with haemorrhagic transformation with parenchymal hematoma. Conclusion Endovascular recanalization treatment with emergency carotid artery stenting is technically feasible. Further refinement of patient selection may reduce postprocedural hemorrhaghic transformation and optimise resultant clinical outcomes. Disclosures N. Ohara: None. S. Tateshima: None. J. Sayre: None. G. Duckwiler: None. R. Jahan: None. N. Gonzalez: None. P. Vespa: None. L. Ali: None. J. Saver: None. D. Liebeskind: None.
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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) | 0.000 | 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 | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.014 | 0.004 |
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".