INFluence of Revascularization Attempts on Clinical Outcomes of Mechanical Thrombectomy Patients and its Economic BURDEN
Bibliographic record
Abstract
Background Emerging evidence suggests that clinical and economic benefits of treatment with mechanical thrombectomy vary by level of reperfusion achieved, and the number of passes required to achieve revascularization. This study aimed to investigate theINFluence of revascularizationAttempts onClinical outcomes of mechanicalThrombectomy and the economicBURDEN (INFACT BURDEN)in Ireland using single center real‐world data from the Irish National Thrombectomy Service database. Methods Primary clinical outcomes were reperfusion (modified thrombolysis in cerebral infarction 2b‐3 or <2b) and functional outcome (90‐day modified Rankin Scale ≤2 or modified Rankin Scale >2) among patients treated with 1–3 passes compared with ≥4 passes. Multivariable generalized linear models examined the association between number of passes with outcomes, with adjustment for covariates that may affect outcomes (eg, age, pre‐procedure modified Rankin Scale, National Institutes of Health Stroke Scale, Alberta Stroke Program Early CT Score, occlusion site, time from symptom onset to groin puncture). A 90‐day decision‐tree and Markov model with a 5‐year time horizon evaluated the cost‐effectiveness of mechanical thrombectomy from the Irish public healthcare payer perspective. Results Eight hundred twenty three patients met the inclusion criteria. Compared with patients in the ≥4 passes group, patients in the 1–3 passes group achieved a significantly higher rate of successful reperfusion (94% versus 78%, odds ratio [OR], 4.7;P<0.001) and a higher rate of functional independence (49% versus 33%, OR, 2.0;P<0.001). Patients in the 1–3 passes group had a shorter time from onset to reperfusion, lower incidence of procedural complications, including distal emboli into non‐involved territory and intra‐procedure rupture, as well as lower 90‐day mortality. The cost‐effectiveness analysis demonstrated that patients successfully revascularized in 1–3 passes had 0.19 additional QALYs and lower costs (€3328; $3800) such that 1–3 passes was dominant compared with ≥4 passes over a 5‐year time horizon. Conclusion This study illustrates that the number of passes has a significant effect on both clinical outcomes and health care costs.
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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 | 0.002 | 0.014 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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 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".