E-028 The impact of time delays on endovascular reperfusion success in late window stroke patients
Bibliographic record
Abstract
Introduction Delays have a negative impact on successful reperfusion with endovascular thrombectomy (EVT) in early-window strokes. Late window patients may be further disadvantaged due to their late presentation. We assessed the impact of delays on reperfusion success in late window stroke patients. Materials and Methods We pooled data from seven trials and registries in North America, Europe, and Korea, for anterior circulation stroke patients treated with EVT between 6 and 24 hours from onset. We explored the impact of delays across multiple time metrics, including onset (or last known well) to hospital arrival; hospital arrival to arterial puncture; and CT to arterial puncture. Our primary outcome was successful reperfusion, defined as a final thrombolysis in cerebral infarction (TICI) score of 2b-3. Univariable and multivariable logistic regression analyses were performed to assess the association between each of the time metrics and successful reperfusion; adjusting for age, sex, occlusion site, NIHSS score, and wake-up stroke status. Results We included 608 patients. The median age was 70 years (IQR: 21), 307 [50.2%] were females, and 311 (53.2%) had wake-up strokes. All patients had CT and CT angiography imaging, and 379 patients (62.3%) also underwent perfusion imaging. Successful reperfusion was achieved in 494 (81.2%) patients. Patients with successful reperfusion were more likely to have had wake-up strokes (55.7% versus 42.7%, p=0.02) and lower NIHSS scores (median 15 [IQR 8] versus 17 [10], p=0.02) compared to unsuccessful reperfusion patients. Successfully reperfused patients had a significantly shorter hospital arrival to arterial puncture time (90 minutes [60–150] versus 110 minutes [84.5–150], p=0.01) compared to unsuccessfully reperfused patients. The odds of successful reperfusion decreased by 6% for every one-hour delay in arrival to puncture (adjusted OR 0.94, 95% CI 0.89–0.99). The CT to puncture time was not different between the successful versus unsuccessful reperfusion patients in univariable and multivariable analyses (65 minutes [39–111] versus 66 minutes [46–105], p=0.33). The onset (last known well) to hospital arrival was longer in the successful reperfusion patients (555 minutes [412–692] versus 436 minutes [362–639.5], p=0.01). This difference, however, did not persist in the multivariable analysis (adjusted OR 1.07 for every one-hour delay, 95% CI 0.93–1.23). Conclusion Faster hospital arrival to arterial puncture time is associated with a higher rate of successful reperfusion in late window stroke patients. Pre-hospital delays were not associated with subsequent reperfusion. Disclosures I. Alhabli: None. F. Benali: None. S. Murphy: None. D. Toni: None. P. Michel: None. M. Hill: None. D. Herlihy: None. I. Casetta: None. S. Power: None. V. Saia: None. A. Hegarty: None. G. Pracucci: None. A. Demchuk: None. S. Mangiafico: None. K. Boyle: None. M. Goyal: None. S. Nannoni: None. E. Fainardi: None. J. Thornton: None. B. Kim: None. B. Menon: None. M. Almekhlafi: None. F. Bala: 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 | 0.004 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.003 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.019 | 0.002 |
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".