Alternative technique for clot retrieval: The “tip of the iceberg” technique
Bibliographic record
Abstract
We present a variation of the classical technique of stent retriever thrombectomy which we found helpful in two patients presenting with acute stroke. CT angiography in both patients demonstrated thrombus within a middle cerebral artery M2 branch. In both cases the occluded artery was not visualized on DSA and only the proximal tip of the clot could be seen as a filling defect "hanging" into the parent artery reminiscent of a "tip of an iceberg". Rather than selectively catheterizing the occluded branch we placed the stent retriever in the patent parent artery crossing only the tip of the clot. In both cases one pass of the stent retriever was sufficient to retrieve the whole clot by its tip and reopen the occluded branch. We suggest trying this technique whenever the clot is seated in the proximal part of a secondary branch such as an M2 segment of middle cerebral artery. This "tip of the iceberg" technique prevents the need to selectively catheterize the occluded branch which, if difficult, can prolong procedural and ischemic time.
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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) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.004 |
| Insufficient payload (model declined to judge) | 0.002 | 0.002 |
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".