O-007 Carotid stent cell design modified the periprocedural outcomes in the stenting arm of randomized trials of carotid revascularization: a meta-analysis: Abstract O-007 Figure 1
Bibliographic record
Abstract
Introduction Trials describe a risk of stroke of about 6% following carotid artery stenting (CAS). Stent cell design has been implicated as a potential factor in these risks. The small free cell area between the struts of a closed-cell stent theoretically provides better scaffolding of the vessel wall and superior plaque stabilization compared to the larger uncovered gaps in open-cell stents. No comparison between stent designs, and their relative effects on clinical outcome compared with carotid endarterectomy, has yet been published in the literature. Materials and Methods This is an exploratory meta-analysis of randomized control trials (RCTs) comparing carotid endarterectomy (CEA) to CAS stratified by the stent cell design. A comprehensive literature search was conducted on major scholar search engines until July 2010. The primary outcome was a composite of the 30-day risk of stroke or death. A Mantel-Hansel random-effects model was used to calculate OR and 95% CIs. Results Nine RCTs (4949 patients) were included in the final analysis. Closed-cell stent design was used in 807 patients and open-cell stents in 1657 patients, while 2485 patients were treated with CEA. The primary outcome was significantly lower in the CEA arm compared to CAS using open-cell design arm (OR 1.84, 95% CI 1.23 to 2.75; p=0.003). However, there was no significant difference in the primary outcome between CEA and CAS using closed-cell design, although a trend favoring CEA was noted (OR 1.54; 95% CI 0.69 to 3.47; p=0.29), Abstract O-007 figure 1. If only the 30-day stroke rate was considered, the difference between CEA and CAS in the closed-cell stents is still non-significant (OR 2.92; 95% CI 0.52 to 16.21; p=0.22), compared to open-cell stents which continued to be inferior to CEA (OR 1.97; 95% CI 1.33 to 2.92; p=0.0007). Abstract O-007 Figure 1 (A) Periprocedural stroke or death with CEA vs Open- cell stents. (B) Periprocedural stroke or death with CEA vs Closed- cell stents. Conclusion In this meta-analysis of nine RCTs, CEA was not superior to CAS in trials using closed-cell stents. While these results may suggest better outcomes of CAS using the closed-cell stents, trials included in this analysis did not randomize patients to open- vs closed-cell stents. Furthermore, trials using the closed design recruited fewer patients than those using open-cell stents. Further assessment of a potential modification of CAS outcomes by stent design is underway with a meta-analysis of prospective CAS cohorts and registries to directly compare open- vs closed-cell stents. Competing interests None.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.022 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.004 | 0.022 |
| Bibliometrics | 0.001 | 0.001 |
| 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) | 0.001 | 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 teacher head, 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".