Prospective Late Endovascular Treatment in Acute Ischemic Stroke Evaluating Non-Contrast Head CT Versus CT Perfusion (PLEASE No CTP) (P1.198)
Bibliographic record
Abstract
BACKGROUND: Studies have shown lack of agreement/usefulness of computed tomography perfusion (CTP) in selection of appropriate acute ischemic stroke (AIS) patients for endovascular treatment (ET). OBJECTIVES: To demonstrate non-contrast computed tomography (CT) within 8 hours of AIS symptom onset is comparable to CTP imaging. METHODS: We prospectively studied all consecutive anterior circulation AIS patients with National institute of health stroke scale (NIHSS) >7 who were treated within 8 hours of symptom onset with ET at two stroke centers from March 2011 to June 2015. All patients had a CT, CT angiography and CTP. ET operator was blinded to results of CTP and based their decision on treatment using the Alberta Stroke Program Early CT score (ASPECTS). Every patient had CT 24 hours post ET as well as after any suspected deterioration. Baseline demographics, co-morbidities, and baseline NIHSS were collected. Outcomes were discharge modified Rankin scale (mRS), and in-hospital mortality. Good outcomes were defined as mRS of 0-2. CTP studies were analyzed for “Penumbra” based on previously published criteria. RESULTS: A total of 283 AIS patients were screened and 119 were enrolled. Mean admission NIHSS and ASPECTS were 16.8 ± 3, and 8.4 respectively. Correlation of CTP with penumbra and without penumbra with good outcomes (50[percnt] vs 47.8[percnt]) was not statistically significant. Mortality in patients with no evidence of CTP penumbra was 22.5[percnt] versus those with CTP penumbra was 22.1[percnt]. ASPECT >7 versus <7 had good outcomes 64.6[percnt] vs 13.3[percnt], p<0.001; and less mortality (10[percnt] vs 51.4[percnt], p<0.001) respectively. CONCLUSIONS: “Penumbra” pattern on CTP did not identify patients who would benefit from ET when patients were selected with a non-contrast CT ASPECTS >7. There was no correlation of CTP penumbra with good outcomes. Larger prospective trials are warranted to justify the wide use of CTP within 8 hours of symptom onset.
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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 | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".