Abstract WP36: The Role of Intravenous Thrombolysis in Patients With Acute Ischemic Stroke Treated With Mechanical Thrombectomy
Bibliographic record
Abstract
Introduction: Mechanical thrombectomy (MT) improves clinical outcome of patients with acute ischemic stroke (AIS) and a large vessel occlusion. Approximately 90% of patients in the recent MT trials received intravenous thrombolysis (IVT) prior to MT. Aim: To determine if IVT in combination with MT is superior to MT alone in patients with AIS and a large vessel occlusion. Methods: A patient-level pooled analysis of the STAR and SWIFT studies, two large multicenter prospective studies on MT for AIS was utilized. Using multivariate logistic regression analysis, we compared mRS at follow-up, reperfusion rates, and complication rates (intracerebral hemorrhage and emboli to uninvolved territories) between patients who underwent MT following IVT, to those who underwent only MT. An independent core laboratory scored all radiological outcomes. Results: Of 291 included patients, 160 (55%) underwent MT following IVT, and 131 (45%) underwent only MT. Of the patients treated with IVT, 116 were IVT failures (full tpa dose) and 44 received bridging therapy (mean tpa dose 0.62 mg/kg). Patients who received IVT less often had atrial fibrillation (33 vs. 47 %, p=0.016) and diabetes (14 vs. 24%, p=0.023), and had a lower mean ASPECTS (8.1 vs. 8.5, p=0.031) compared to thos who underwent only MT. There was no difference in baseline NIHSS (both median 17) or location of the occlusion between groups. We did not find a statistically significant association between use of IVT in addition to MT vs. MT alone for any of the outcomes. There were trends towards a lower risk of symptomatic intracerebral hemorrhage (adjusted OR 0.12, 95% CI 0.01-1.13), a higher risk of vasospasm (adjusted OR 1.81, 95% CI 0.86-3.80), and a higher chance of mRS 0-2 (adjusted OR 1.60, 95% CI 0.86-3.80) in patients who received MT following IVT, compared to MT alone. Conclusions: We observed no statistically significant benefit or harm for the use of IVT in addition to MT in patients with AIS and a large vessel occlusion.
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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 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| 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".