P-031 Mechanical thrombectomy with the solitaire device: is there a learning curve toward achieving rapid recanalization times?: Abstract P-031 Figure 1
Bibliographic record
Abstract
Introduction/Purpose We evaluated recanalization times with the Solitaire device in patients undergoing endovascular acute ischemic stroke therapy at our institution. Materials and Methods We reviewed patients who presented to our stroke center and in whom a Solitaire device was used for revascularization. Demographic data and stroke severity were obtained from chart review. Time points for CT scanning, angiography arrival, puncture, time of first deployment of the device and recanalization times were recorded from time-stamped PACS images and angiography records. Time intervals were calculated (CT to angiography arrival, angiography arrival to puncture, puncture to first deployment and deployment to recanalization). To evaluate time interval trends, recanalized patients were sequentially divided into three sequential groups. Overall CT to recanalization time and interval times between groups were compared using an analysis-of-variance (ANOVA) test. In addition, we also looked for difference between groups using the Scheffe's test correcting for multiple comparisons. All tests are two sided with a p value <0.05 considered to be statistically significant. Analysis was performed using Stata® V.12. Results 83 patients (38 female; mean age: 65.7±14.3) were treated with the Solitaire device from May 2009 to February 2012. The median NIHSS was 17. Recanalization (TIMI 2/3) occurred in 75 (90.4%) patients. CT to recanalization time showed a statistically significant decrease over time (p<0.01). This difference was maximal between first 25 and most recent 25 cases (161 to 94 min, p<0.01). The maximal contribution to this was from improvements in first deployment to recanalization time between the first 25 and second 25 patients (p=0.01) and between the first and third 25 patients (p=0.001) with modest contributions from moving patients from CT to the angiography-suite faster (p=0.02 between 1st and 3rd groups) and from puncture to first deployment (p=0.02 between 1st and 3rd groups). There was no statistically significant difference in time from angiography-suite arrival to puncture between the groups (Abstract P-031 figure 1). Abstract P-031 Figure 1 Conclusion There appears to be a learning curve involved in the efficient use of the Solitaire device in endovascular acute stroke therapy. Along with slight improvements in moving patients to angiography sooner and improved efficiency with intracranial access, mastering this device contributed significantly toward the overall drive to reduce recanalization times in stroke patients treated by an endovascular approach at our institution. This needs to be validated in a prospective manner to understand components of this learning curve that is potentially useful to educate new users to achieve faster recanalization times. Competing interests 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 | 0.004 |
| 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 | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.007 | 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".