E-224 Outcomes of mechanical thrombectomyin stroke patients with extreme large infarction core
Bibliographic record
Abstract
Introduction Recent clinical trials have demonstrated that patients with large vessel occlusion (LVO) and large infarction core may still benefit from mechanical thrombectomy (MT). However, limited data is available about the outcomes of MT in LVO patients presenting with extreme large infarction core (Alberta Stroke Program Early CT Score (ASPECTS) of 0-2). Methods Data from Stroke Thrombectomy and Aneurysm Registry (STAR), which combined the prospectively maintained databases of 84 thrombectomy-capable stroke centers in the US, Europe, and Asia, was interrogated. We identified thrombectomy patients presenting with an occlusion in the intracranial internal carotid artery (ICA) or M1 segment of the middle cerebral artery (MCA) and extreme large infarction core (ASPECTS 0-2). Patients with tandem occlusion were excluded from these analyses. Favorable outcome was defined by achieving achieved modified Rankin scale (mRS) of 0-2 at 90 days post-MT. Successful recanalization was defined by achieving a Modified Thrombolysis in Cerebral Infarction (mTICI) score of ≥2B. Results We identified 47 patients who presented with ASPECTS 0-2 and underwent MT (24 had M1 occlusion and 23 had intracranial ICA occlusion). The average age was 69.4; 26 (55.3%) were females, 45 (95.7%) were White, and 13 (27.7%) patients received IV-tPA. Aspiration thrombectomy was performed in 31 (65.9%) patients and a Stent retriever (SR) was used in 11 (34.1%) patients. Peri-procedural complications occurred in 3 (6.4%) patients and symptomatic hemorrhagic transformation (sICH) was seen in 6 (12.8%) patients. Regarding 90-day outcomes, 8 (17%) patients achieved favorable outcome (mRS 0-2), and the mortality rate was 42.6%. Patients who achieved mRS of 0-2 were all females (100% versus 46.2%, P=0.005), achieved successful recanalization (100% versus 87.2%, P=0.284) and were more likely to have received IV tPA (62.5% versus 20.5%, P=0.016). On multivariable analysis, only admission National Institutes of Health stroke scale (NIHSS) on admission was independently associated with favorable outcome (OR 0.801, 95% CI 0.642-0.999, P=0.049). Conclusion About one in five patients presenting with extreme large infarction core (ASPECTS 0-2) may achieve a favorable 90-day functional outcome following MT. However, MT in this group of patients was associated with high mortality and sICH rate. Disclosures E. Almallouhi: None. M. Anadani: None. S. Samir Elawady: None. M. Mahdi Sowlat: None. I. Maier: None. P. Jabbour: None. J. Kim: None. S. Quintero Wolfe: None. A. Rai: None. R. M Starke: None. M. Psychogios: None. E. Samaniego: None. A. Arthur: None. S. Yoshimura: None. J. A. Grossberg: None. A. Alawieh: None. J. Mascitelli: None. I. Fragata: None. H. Cuellar: None. A. Polifka: None. J. Osbun: None. R. Crosa: None. C. Matouk: None. M. S. Park: None. M. R. Levitt: None. W. Brinjikji: None. T. Dumont: None. R. Williamson Jr.: None. P. Navia: None. A. M Spiotta: None. S. Al Kasab: 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 | 0.000 | 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 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
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".