Proximal Hyperdense Middle Cerebral Artery Sign is Associated with Increased Risk of Hemorrhagic Transformation after Endovascular Thrombectomy: A Multi-center Retrospective Study
Bibliographic record
Abstract
Abstract Objective: To investigate whether hyperdense middle cerebral artery sign (HMCAS) on pretreatment no-contrast CT (NCCT) is associated with hemorrhagic transformation (HT) after endovascular thrombectomy (EVT). Methods: Patients with acute middle cerebral artery (MCA) occlusion who received EVT between January 2018 and December 2021 in three comprehensive hospitals were retrospectively evaluated. They were divided into negative HMCAS, proximal HMCAS, and distal HMCAS groups, among whom differences were compared. Univariate and multivariate logistic regression analysis were performed to investigate the association between HMCAS and HT. Results: 318 patients were included, among whom 149 (46.9%) had HMCAS with 107 (71.8%) in the proximal HMCAS group and 42 (28.2%) in the distal HMCAS group. Patients with proximal HMCAS had higher National Institute of Health Stroke Scale scores (p = 0.006) and lower Alberta Stroke Program Early CT Scores (p < 0.001). Large artery atherosclerosis was more frequent in the negative HMCAS group while cardioembolism was more common in the positive HMCAS groups (p = 0.007). The rate of HT was higher in the proximal HMCAS group than that in the negative HMCAS group (61.7% vs 43.2%, p < 0.05). Proximal HMCAS was associated with HT in univariate analysis (unadjusted OR = 2.117, 95%CI: 1.291–3.471, p = 0.003) and remained an independent risk factor of HT in multivariate logistic regression analysis (adjusted OR = 1.989, 95%CI: 1.170–3.380, p = 0.011). Conclusion: Proximal HMCAS on initial NCCT was independently associated with HT in patients who received EVT for acute MCA occlusion.
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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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 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".