Abstract WMP4: Bridging Thrombolysis In Stroke Patients With Low Aspects Prior To Endovascular Thrombectomy
Bibliographic record
Abstract
Background: In stroke patients with large vessel occlusion and extensive early ischemic change, the role of bridging thrombolysis prior to endovascular thrombectomy (EVT) is still to be determined. Aim: To examine the impact of ischemic change on the efficacy and safety of bridging thrombolysis in patients treated with EVT. Methods: Consecutive anterior circulation EVT patients from a prospectively collected registry were included in this retrospective analysis. Alberta stroke programme early CT scores (ASPECTS) were evaluated from initial non-contrast CT scan with lower score indicating larger areas of early ischemic change. Outcome measures included symptomatic intracranial hemorrhage and functional independence (modified Rankin scale score 0-2) at day 90. Multivariable logistic regression models with interaction terms between ASPECTS and bridging thrombolysis were created. ASPECTS was treated as numeric variable in the primary analysis and trichotomized (ASPECTS ≤5, 6-8, 9-10) in a sensitivity analysis. Results: 872 EVT patients (384 female, mean ± SD age of 67 ± 15, baseline NIHSS 16 [IQR 11-20], median ASPECTS 8 [range 2-10]) were included. 436 (50%) received bridging intravenous thrombolysis with alteplase. There was no significant main effect of ASPECTS on sICH (main effect OR 0.73 95%CI 0.45-1.21, p=0.24) and no modifying effect of thrombolysis (interaction p=0.65). With decreasing numeric ASPECTS, the probability of functional independence reduced (main effect OR 1.34 95%CI 1.20-1.49, p<0.001), and this the reduction was steeper in those without bridging thrombolysis (interaction p=0.035). The interaction was not significant when ASPECTS was split into the 3 categories (p=0.28). Conclusion: In anterior circulation patients treated with EVT, bridging thrombolysis was associated with a higher probability of functional independence in those with more extensive early ischemia as determined by ASPECTS. These results suggest patients with large ischemic cores may still benefit from bridging thrombolysis, but this will need to be evaluated in further studies.
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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 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| 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".