Efficacy of emergent internal carotid artery stenting after intracranial thrombectomy for acute internal carotid artery stenosis related tandem lesions
Bibliographic record
Abstract
Objective To investigate the efficacy and safety of emergent carotid artery stenting (CAS) after intracranial artery mechanical thrombectomy for acute internal carotid artery (ICA) stenosis related tandem lesions. Methods A total of 79 patients with acute ICA stenosis related tandem lesions admitted to the Advanced Stroke Center of Zhangzhou Hospital affiliated to Fujian Medical University from January 2015 to December 2019 were selected. All patients underwent urgent endovascular therapy with "half" anterograde approach with or without usage of embolic prevention device (EPD) technology, and divided into CAS group (n=47) and non⁃CAS group (n=32) according to whether CAS was performed in emergency. Compared and analysed the 2 groups of surgical related indexes [including the preoperative Alberta Stroke Program Early CT Score (ASPECTS), the occlusion site of tandem lesions, the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology Collateral Flow Grading System (ASITN/SIR ACG), puncture⁃to⁃reperfusion time, leakage on C⁃arm CT, incidence of distal embolism], and the clinical prognostic indicators [including the incidence of symptomatic intracranial hemorrhage (sICH), culprit artery reocclusion rate, postoperative 90⁃d favorable outcome rate and mortality]. Univariate and multivariate forward Logistic regression were used to analysis the influencing factors of postoperative 90⁃d poor prognosis in acute ICA stenosis related tanchem lesions. Results All 79 patients had immediate postoperative mTICI grading≥2b, the vascular recanalization rate was 100%. There was no statistically significant differences in the preoperative ASPECTS (t=⁃0.170, P=0.865), the occlusion site of tandem lesions (Z=5.907, P=0.091), the ASITN/SIR ACG (t=⁃0.900，P=0.368）, puncture⁃to⁃reperfusion time (t=0.182, P=0.856), leakage on C⁃arm CT (Z=⁃0.171, P=0.864), incidence of distal embolism (χ2=0.872, P=0.350), the incidence of sICH (χ2=1.670, P=0.434), the culprit artery re⁃occlusion rate (χ2=0.000, P=1.000), postoperative 90⁃d favorable outcome rate (χ2=2.149, P=0.143) and the mortality (χ2=0.150, P=0.699) between CAS group and non⁃CAS group. Logistic regression analysis showed that increasing age (OR=1.078, 95%CI: 1.011-1.148; P=0.021), leakage on C⁃arm CT (OR=5.163, 95%CI: 1.633-16.326; P=0.005) were risk factors for postoperaive 90⁃d poor outcomes of the patients with acute carotid atherosclerotic stenosis related tandem lesions. Conclusions For patients with acute ICA stenosis related tandem lesions used "half" anterograde approach with or without usage of EPD technology, the decision of emergent CAS after mechanical thrombectomy was made according to the stenosis degree of ICA and leakage on C⁃arm CT. This strategy is safe and feasible, and has the potential of clinical promotion.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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".