LB-004 Intravenous alteplase has different effects on the efficacy of aspiration and stent retriever thrombectomy: analysis of the COMPASS trial
Bibliographic record
Abstract
Background There is conflicting evidence on the utility of intravenous (IV) Alteplase in patients with emergent large vessel occlusion treated with mechanical thrombectomy (MT). The goal of this study was to examine whether there were differences in procedural and technical outcomes of MT depending on whether patients received IV Alteplase prior to intervention using the COMPASS dataset. Methods This was a post hoc analysis of the COMPASS: A trial of aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion. We compared clinical, procedural and angiographic outcomes of patients with and without prior IV Alteplase administration. In order to compare outcomes in patients treated with MT according to the use of IV Altepase, only patients presenting to the emergency department (ED) of the first hospital of arrival within 4 hours of stroke symptom onset or last known normal were included in our analysis. Results Of the 270 patients included in the COMPASS trial, 235 (87%) arrived to the ED within the first 4 hours of stroke symptom onset and were eligible for the post-hoc analysis. (115 patients in the aspiration first and 120 in the SR first groups, respectively).Atrial fibrillation was more frequently seen in the MT only when compared to the combined group (65.5% vs 38.6%, respectively, P<0.001). Other vascular risk factors, age, NIHSS severity, and the distribution of occlusion sites showed no statistically significant difference. On univariate analysis, administration of IV Alteplase prior to MT was found to be significantly associated with favorable outcomes (modified Rankin scale [mRS] 0–2 at 3 months; 55.6% vs 40% in the MT only group, P=0.037). However, on multivariate analysis only baseline (pre-stroke) mRS, admission NIHSS score and age were identified as independent predictors of favorable outcomes at 3 months. We found higher final TICI 2b/3 rates in patients without the use of Alteplase prior to the aspiration first approach (100% vs 87.9% in IV Altepase + aspiration first MT, P=0.03). In the SR first group, final TICI 2b/3 rates were identical in patients with and without IV Alteplase administration (87.5% and 87.5%, P=1.0). Conclusions Prior administration of IV Alteplase is not associated with improved procedural or clinical outcomes in patients with anterior circulation ELVO treated with MT. Alteplase may adversely affect the efficacy of aspiration first approach, but does not seem to influence the stent retriever first approach to MT. Disclosures M. Mokin: 1; C; NIH R21NS109575. 2; C; Cerenovus, Medtronic. 4; C; Brain Q, Endostream Serenity medical, Synchron. M. Waqas: None. J. Fifi: 2; C; Stryker, Penumbra, Microvention. 4; C; Cerebrotech, The Stroke Project. R. De Leacy: 2; C; Penumbra, Cerenovus, Siemens, Imperative Care. 4; C; Synchron, Endostream, Q’Apel. D. Fiorella: 2; C; Balt USA, Penumbra, Cerenovus, Stryker, Genentech, Shape Memory Medical, Marbelhead, Medtronic, MENTICE, Neuorogami, RAPID AI, Rapid medical, Phenox. E. Levy: 2; C; Penumbra, NextGen Biologics, Rapid Medical, Cognition Medical, Three Rivers Medical, Stryker, MedX, Endostream Medical. K. Snyder: 2; C; Penumbra, Canon Medical Systems, Medtronic, Jacobs Institute, Neurovascular Diagnostics. R. Hanel: 2; C; Penumbra, Endostream, Cerebrotech, Synchron, InNeuroCo, Medtronic, Microvention, Stryker, Cerenovus; Elum, Three Rivers. K. Woodward: None. I. Chaudry: 2; C; Medtronic, Microvention, Penumbra. 4; C; Cerenovus, Serenity Medical, Cerebrotech, Three Rivers Medical, Q’apel. A. Rai: 2; C; Penumbra, Microvention, Stryker. D. Frei: 2; C; Penumbra, Cerenovus, Stryker, Genentech, Shape Memory Medical, Siemens. J. Delgado Almandoz: 2; C; Penumbra, Medtronic. M. Kelly: 2; C; Penumbra, Medtronic, Endostream. A. Arthur: 2; C; Cerenovus, Medtronic, Microvention, Penumbra, Scientia, Siemens, Stryker. 4; C; Bendit, Cerebrotech, Endostream, Magneto, Marblehead, Neurogami, Serenity, Synchron, Triad, Vascular Simulations. B. Baxter: 2; C; Penumbra , Medtronic, Stryker, Cerenovus, Viz.ai, 880 medical, Route 92, Artio Medical. J. English: 2; C; Penumbra, Medtronic, Stryker, Route 92 Medical. I. Linfante: 2; C; Penumbra, Medtronic, Stryker, Microvention, InNeuroCo, Three Rivers. K. Fargen: None. A. Turk: 2; C; Cardinal consulting, Cerenovus, Corindus, Medtronic, Siemens, 880 medical. 4; C; Cerebrotech, Endostream. Imperative care, Three rivers medical, Vastrax, Shape memory, Synchron, Serenity medical, Blink TBI, Echovate, RIST, Apama, Q’Apel, VizAi, Early bird medical, Rapid medical, S. J. Mocco: 2; C; Imperative Care, Cerebrotech, VIseon, Endostream, Vastrax, RIST, Synchron, Viz.ai, Perflow and CVAid. 4; C; Cerebrotech, Imperative Care, Endostream, Viseon, BlinkTBI, Serenity, Cardinal Consulting, NTI, RIST, Viz.ai, Synchron. A. Siddiqui: 2; C; Amnis Therapeutics, Apellis Pharmaceuticals, Inc., Boston Scientific, Canon Medical Systems USA, Inc., Cardinal Health 200, LLC, Cerebrotech Medical Systems, Inc., Cerenovus, Cerevatech Medical, Inc.,. 4; C; Adona Medical, Inc., Amnis Therapeutics, Bend IT Technologies, Ltd., BlinkTBI, Inc, Buffalo Technology Partners, Inc., Cardinal Consultants, LLC, Cerebrotech Medical Systems, Inc, Cerevatech Medical.
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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 | 0.006 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.005 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 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".