Baseline Occlusion Angiographic Appearance on Mechanical Thrombectomy Suggests Underlying Etiology and Outcome
Bibliographic record
Abstract
Background Etiology of a large vessel occlusion is relevant in the management of acute ischemic stroke patients and often difficult to determine in the acute phase. Aims We aim to investigate whether the angiographic appearance of the occlusion is related to its etiology and outcome. Materials and Methods Patients without cervical carotid occlusions who underwent mechanical thrombectomy in our center from April 2015 to September 2018 were studied. Demographics, clinical and radiological variables and outcome measures, including etiological classification of stroke, were collected. Underlying intracranial atherosclerosis was estimated according to the presence of stenosis after recanalization. Patients were assigned to groups based on the appearance of the occlusion observed in the first angiogram as “tapered” or “non-tapered”. Differences were searched amongst them. Results 131 patients met inclusion criteria. 31 (23.6%) were “tapered” and 100 (76.3%) non-tapered. Tapered presented lower mean baseline NIHSS (10.3 ± 6.2 vs 16.1 ± 7.2; p<0.001), smaller acute infarct cores as CTP CBV ASPECTS (8.6 ± 1.6 vs 7.2 ± 2.4; p=0.003), higher proportion of instant re-occlusions (26.7% vs 8.2%; p=0.025), fewer complete recanalization (45.2% vs 71.0%; p=0.028), and more persistent occlusions (37.5% vs 10.6%; p=0.011) on follow up MRA. There were no differences in reperfusion rates (83.9% vs 84.0%; p=0.986) nor in good long term functional outcome (50.0% vs 51.1%; p=0.921). Intracranial atherosclerosis etiology was more common in tapered than in non-tapered occlusions (54.8% vs 18.0%; p<0.001). Conclusion The angiographic appearance of an occlusion in mechanical thrombectomy patients may determine its etiology, predict likelihood of successful recanalization and risk of reocclusion.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| 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 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".