Endovascular Treatment Decisions in Patients with M2 Segment MCA Occlusions
Bibliographic record
Abstract
<h3>BACKGROUND AND PURPOSE:</h3> Endovascular therapy in acute ischemic stroke is rapidly evolving. We explored physicians’ treatment attitudes and practice in patients with acute ischemic stroke due to M2 occlusion, given the absence of Level-1 guidelines. <h3>MATERIALS AND METHODS:</h3> We conducted an international multidisciplinary survey among physicians involved in acute stroke care. Respondents were presented with 10 of 22 case scenarios (4 with proximal M2 occlusions and 1 with a small-branch M2 occlusion) and asked about their treatment approach under A) current local resources, and B) assumed ideal conditions (no monetary or infrastructural restraints). Overall treatment decisions were evaluated; subgroup analyses by physician and patient baseline characteristics were performed. <h3>RESULTS:</h3> A total of 607 physicians participated. Most of the respondents decided in favor of endovascular therapy in M2 occlusions, both under current local resources and assumed ideal conditions (65.4% versus 69.6%; <i>P</i> = .017). Under current local resources, older patient age (<i>P</i> < .001), longer time since symptom onset (<i>P</i> < .001), high center endovascular therapy volume (<i>P</i> < .001), high personal endovascular therapy volume (<i>P</i> = .005), and neurosurgeons (<i>P</i> < .001) were more likely to favor endovascular therapy. European respondents were less likely to favor endovascular therapy (<i>P</i> = .001). Under assumed ideal conditions, older patient age (<i>P</i> < .001), longer time since symptom onset (<i>P</i> < .001), high center endovascular therapy volume (<i>P</i> = .041), high personal endovascular therapy volume (<i>P</i> = .002), and Asian respondents were more likely to favor endovascular therapy (<i>P</i> = .037). Respondents with more experience (<i>P</i> = .048) and high annual stroke thrombolysis treatment volume (<i>P</i> = .001) were less likely to favor endovascular therapy. <h3>CONCLUSIONS:</h3> Patients with M2 occlusions are considered appropriate candidates for endovascular therapy by most respondents in this survey, especially by those performing endovascular therapy more often and those practicing in high-volume centers.
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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 | 0.000 |
| 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".