Abstract 2549: Favorable Vascular Profile Is An Independent Predictor Of Outcome: A Post Hoc Analysis Of The Sentis Trial
Bibliographic record
Abstract
Background: The Safety and Efficacy of NeuroFlo TM Technology in Acute Ischemic Stroke (SENTIS) trial was the first randomized interventional stroke study for hemodynamic augmentation by partial aortic occlusion to improve neurological outcome versus standard medical management. We hypothesized that a favourable vascular profile (FVP) defined as anatomical intactness of the Circle of Willis (CoW, including visualization of the communicators) combined with a stable cerebral perfusion pressure (CPP) is a prerequisite for collateral recruitment and maintenance. We performed post hoc analyses to identify whether a favorable vascular profile (FVP) is associated with independent outcome. Methods: We identified all patients from the primary dataset (n=515 patients) with available intracranial vascular imaging (MRA, CTA, or conventional angiography) at baseline. Two independent readers evaluated the vascular imaging blind to clinical and treatment data. CPP compromise was assumed in critical hypotension defined as mean arterial blood pressure (MAP) drop below 65mmHg. FVP was scored, when CoW was intact and MAP >65mmHg at all timepoints within the first 12h of the NeuroFlo procedure. We performed univariate and multivariate analyses to identify predictors of independent outcome (mRS 0-2) at 90 days. Results: 192/515 SENTIS subjects had available baseline vascular imaging (91 treated / 101 controls). Baseline characteristics did not differ between groups (age, weight, infarct side, NIHSS, race, time from symptom onset, vital parameters, cardiovascular risk factors including atrial fibrillation (AF), medical history). Overall, FVP was seen in 89.6% of patients with a trend in favor of treated patients (94.5% vs 85.2%, p=0.0562). Nevertheless, presence of FVP predicted independent outcome in univariate (OR=7.46, 1.68-33.18, p=0.0082) and multiple logistic regression analyses after adjustment for all variables (OR=10.22, 1.78-58.57, p=0.0091). Aside from FVP, only baseline NIHSS (OR=0.74, 95% CI 0.67-0.82, p<0.0001) and presence of atrial fibrillation (OR=0.48, 95% CI 0.21-1.12, p=0.0909) entered the predictive model. There was no interaction with randomization to treatment or control. Conclusion: FVP and baseline NIHSS independently predicted outcome in this subset of the SENTIS population. FVP is a novel parameter to predict outcome of acute stroke patients and further studies will establish its potential role for selection of optimal candidates for hemodynamic augmentation.
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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 | 0.003 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 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 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".