Thromboaspiration in a Patient With Persisting Intracranial Occlusion After Intravenous Thrombolysis: A Case Report
Bibliographic record
Abstract
The last few years have been characterized by a rapid diffusion of endovascular treatments aimed at achieving arterial recanalization in patients with acute ischemic stroke. Clinical trials have shown higher rates of arterial recanalization being achieved by the Penumbra System (PS) as compared to standard treatment, i.e. systemic thrombolysis by recombinant tissue plasminogen activator (rtPA). This case-report enhances the relevance of strict patient monitoring during and after rtPA administration in order to consider urgent mechanical thrombectomy as additional treatment in highly selected cases. A 69-year-old woman presented with sudden onset of left hemiparesis and slurred speech. Systemic rtPA was administered with marked clinical improvement. Ultrasound study performed during rtPA infusion suggested intracranial occlusion. Diffusion-weighted MRI was negative for acute ischemia, perfusion-weighted imaging detected a wide region of hypoperfused tissue in the right middle cerebral artery (MCA) territory, and MR angiography detected right proximal MCA occlusion. After the initial clinical improvement, the patient deteriorated. Clot aspiration by the PS and complete recanalization were achieved in 56 minutes. The patient was discharged with mild left hemiparesis, and she had excellent recovery at 6 months. Acute endovascular treatment by the PS proved successful in this patient experiencing clinical fluctuations due to persisting intracranial artery occlusion after systemic thrombolysis. Strict patient monitoring by MRI and ultrasound studies may allow prompt mobilization of the interventional radiology team thus offering an increased chance of favourable outcome and preventing more invalidating strokes in patients known to benefit poorly by systemic thrombolysis. doi:10.4021/jnr84w
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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) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.008 | 0.004 |
| Insufficient payload (model declined to judge) | 0.002 | 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".