O-031 Is flow diversion the best treatment of cavernous carotid aneurysms?
Bibliographic record
Abstract
Background and Purpose Cavernous carotid aneurysms can cause pain and ophtalmoplegia from mass effect, but they rarely rupture or cause life threatening complications. Treatment options include observation, parent vessel occlusion, coil embolization, or in the last decade flow-diversion (FD). We aimed to compare the results of FD with more conventional treatments in patients with cavernous aneurysms recruited in the Flow Diverter in the Treatment of Aneurysms trial (FIAT). Materials and methods FIAT, conducted in 3 Canadian hospitals, proposed randomized allocation to flow diversion or standard management options (observation, coil embolization, parent vessel occlusion, or clip placement), and a registry of nonrandomized patients treated with flow diversion. The primary safety outcome was death or dependency (modified Rankin Scale score >2) at 3 months, to be determined for all patients who received flow diversion at any time. The primary efficacy outcome was angiographic occlusion at 3–12 months combined with an independent clinical outcome. Results Forty-two patients with cavernous aneurysms were included in the FIAT study. In 31 patients, treatment was randomly allocated: 17 were treated with FD, 14 using best standard treatment (BST). Eleven patients treated with FD were judged untreatable otherwise. An hemorrhagic complication occurred in 3/28 patients treated with FD (11%; 3.7%–27.2%), as compared to 0/14 with BST (0%–21.5%) Overall, we had a 3% mortality rate and a 7% major neurologic complication rate. Conclusion Flow diversion in CCAs was not safe as hypothesized. We observed unusual and potentially fatal hemorrhagic complications in patients treated with FD that need to be attentively analyzed, especially considered that CCAs hemorrhagic presentation is a rare event. More randomized trials are needed to determine the role of flow diversion in the management of cavernous carotid aneurysms. Disclosures L. Nico: 1; C; Medtronic-Covidien. A. Weill: None. D. Roy: None. J. Raymond: None.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 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".