Abstract WP40: Endovascular Therapy 6 to 24 Hours After Stroke With a Mismatch Between Neurological Deficit and Alberta Stroke Program Early CT Score on Diffusion Weighted Imaging in a Real-World Setting
Bibliographic record
Abstract
Background and Purpose: The DAWN trial showed the efficacy of endovascular thrombectomy between 6 to 24hours after time last known well (TLKW) in acute stroke patients with clinical-imaging mismatch. We examined the validity of patient selection using Alberta Stroke Program Early CT Score on diffusion weighted imaging (DWI-ASPECTS) in a real-world setting. Methods: In a Japanese nationwide registry study, 2420 patients with acute stroke due to large vessel occlusion within 24 hours from onset/TLKW were registered between October 2014 and January 2017. Among them, patients were included according to the inclusion criteria of the DAWN trial where ischemic core volume was replaced with DWI-ASPECTS: occlusion of the internal carotid artery or the middle cerebral artery M1 portion, 6 to 24 hours from onset/TLKW, DWI-ASPECTS ≥7 and initial NIHSS ≥10, and DWI-ASPECTS ≥6 and NIHSS ≥20 in patients younger than 80 years old. The favorable outcome was defined as a modified Rankin Scale of 0 to 2 at 90 days after onset. Results: Of 78 patients who were eligible to inclusion criteria, 54 (69%, mean 75±13 years old) underwent endovascular therapy (EVT) and 24 (31%, mean 76±14 years old) did not. Median initial NIHSS was 18 (IQR, 13-23) and 20 (IQR, 14-23), respectively (p = 0.67). Initial DWI-ASPECTS was significantly higher in the EVT group than in the non-EVT group (median [IQR], 8 [7-9] vs 7 [7-8], p = 0.009). The favorable outcome was achieved in 52% of the EVT group and 13% of the non-EVT group (adjusted odds ratio, 8.1; 95% CI, 2.0-33.3, p = 0.004). In terms of safety outcome, any intracranial hemorrhage within 72 hours was not different between the two groups (24% vs 33%, p = 0.56). The recurrence of stroke (5.6% vs 4.2%, p = 1.00) and mortality (4.2% vs 3.7%, p = 1.00) within 90 days were also not different. Conclusions: Patient selection using clinical-DWI mismatch can be useful to determine the indication of endovascular treatment in late presenting stroke with anterior 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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| 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".