E-161 Intra-arterial tissue plasminogen activator is a safe adjunctive therapy to mechanical thrombectomy
Bibliographic record
Abstract
Introduction Intra-arterial tissue plasminogen activator (IA-tPA) has been widely used in conjunction with mechanical thrombectomy (MT) or as rescue therapy. Data on the safety of IA-tPA during thrombectomy is scarce. Objective To report the safety outcome of MT with IA tPA and compare it to MT without IA-tPA. Methods We reviewed our prospectively maintained data and identified patients who received mechanical thrombectomy between 11/1/2014 to 4/1/2017. Collected variables included demographics, comorbidities, baseline NIHSS, procedural variables and outcome variables. Hemorrhagic transformation (HT) was divided into hemorrhagic infarction and parenchymal hemorrhage (PH) based on ECASS criteria. Functional outcome was assessed based on modified Rankin Scale (mRS). Results Total of 408 patients were included in this study. 57 patients were treated with MT and IA tPA, and 351 were treated with MT alone. Median IA tPA dose was 5 mg (IQR,4–6). Both groups did not differ in baseline characteristics, comorbidities or admission NIHSS. Around 45% of patients achieved a favorable outcome (mRS ≤2) in both groups (p=0.97). The rate of any hemorrhagic complications and parenchymal hemorrhage (PH) did not differ between groups (any hemorrhage; 38.6% vs 35.9%; p=0.69, PH; 10.5% vs 12.3%; p=0.71). Conclusion Intra-arterial tPA is a safe adjunctive therapy to mechanical thrombectomy. ASPECT, Alberta stroke program early CT score; IV tPA, intravenous tissue plasminogen activator; mRS, modified Rankin Scale; NIHSS, National Institutes of Health Stroke Scale; PH, parenchymal hemorrhage; TICI, Thrombolysis in Cerebral Ischemia. Disclosures M. Anadani: None. S. Ajinky: None. A. Alawieh: None. A. Chatterjee: None. J. Vargas: None. R. Turner IV: 1; C; Codman, Penumbra, Microvention, Pulsar Vascular Stock. 2; C; Codman, Covidien, Penumbra, Microvention, Blockade-Stocks, Pulsar Vascular Stock, Medtronic. 3; C; Codman, Covidien, Penumbra, Microvention, Blockade-Stocks, Pulsar Vascular Stock, Medtronic. A. Turk: 6; C; Codman Consulting, Honorarium, Speaker Bureau, Research Funding; Covidien Consulting, Honorarium, Speaker Bureau; Penumbra Consulting, Honorarium, Speaker Bureau, Research Grants; Microvention Consult. M. Chaudry: 6; C; Codman Consulting, Honorarium, Speaker Bureau, Research Funding; Covidien Consulting, Honorarium, Speaker Bureau; Penumbra Consulting, Honorarium, Speaker Bureau, Research Grants; Microvention Consult. A. Spiotta: 6; C; Penumbra Consulting, Honorarium, Speaker Bureau; Pulsar Vascular Consulting, Honorarium, Speaker Bureau; Microvention Consulting, Honorarium, Speaker Bureau, Research; Stryker Consulting, Honorarium.
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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) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
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".