E-083 Safety and efficacy of xact stent in tandem internal carotid artery and intracranial large vessel occlusion
Bibliographic record
Abstract
Introduction Endovascular stenting of the extracranial internal carotid artery (ICA) in the setting of tandem intracranial arterial occlusion (ICAO) is an area of ongoing research. Objective We demonstrate the safety and efficacy of endovascular stenting of the ICA with tandem ICAO using the Xact stent. Design This is a retrospective cohort analysis of all patients presenting to a single academic center with tandem ICA/ICAO who underwent mechanical thrombectomy from 2015-2020. Patients were included per AHA guidelines excluded if pre-procedural angiography did not show tandem occlusions. Main outcomes and measures Baseline variables included age, baseline National Institute of Health Stroke Scale (NIHSS), baseline Alberta Stroke Program Early CT Score (ASPECTS), site of intracranial occlusion, treatment techniques and time efficiencies, and thrombolysis in cerebral infarction score. Outcome measures included modified Rankin scale (mRs) at 90 days, median infarct volume, stent complications, stent re-stenosis rate, recurrent stroke at 30 days and symptomatic intracerebral hemorrhage (sICH). Results A total of 67 patients with symptomatic angiographically-confirmed tandem ICA/ICAO were identified. The median patient age was 66, baseline median NIHSS was 16.2, Mean ASPECTS 8.1, ICAO location was the M1 segment of middle cerebral artery (MCA) in 39% of patients, internal carotid artery terminus in 37%, M2 segment of MCA in 23% and M3 segment of MCA in 1.6% of patients. Successful reperfusion of TICI 2B-3 was achieved in 91% of patients. Favorable mRS of 0-2 was achieved in 52% of cases, mortality was 19%, and median final infarct volume was 30.9mL. The rate of stent complications occurred in 3% of patients, most common being partial in stent thrombosis extending intraluminally. Rate of sICH was 4%, recurrent stroke occurred in 5% of patients within 30 days, and in-stent stenosis >50% happened in 16% at 18 months. No patients required additional interventions. Conclusions The Xact carotid stent is safe and efficacious in the treatment of tandem ICA/ICAO lesions. Larger prospective trials are needed to help confirm our retrospective findings. Disclosures M. Oliver: None. G. Dawod: None. S. Zaidi: None. M. Jumaa: 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 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| 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) | 0.003 | 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".