E-125 Clinical outcomes of mechanical thrombectomy in posterior circulation tandem occlusions: multicenter experience
Bibliographic record
Abstract
Introduction Scarce amount of data currently exist regarding mechanical thrombectomy (MT) outcomes in posterior circulation tandem occlusions, with most available data limited to small single-center series. Methods Series of consecutive patients undergoing MT for tandem posterior occlusions from 15 North-American centers (2016-2022) were included. Inclusion criteria were patients with posterior circulation stroke due to intracranial VA, BA, or PCA occlusion (distal lesion), with tandem occlusion defined as stenosis/occlusion of the extracranial VA with the resultant impaired flow (proximal lesion) rendering potential treatment. The primary radiological outcome was successful recanalization defined as mTICI score of ≥2b, with the clinical endpoint of MT safety and functional outcomes utilizing a modified Rankin Scale (mRS) at 90-days/last available follow-up. Results 138 patients were included (mean age 63±15 years, 35.4% females). The median initial NIHSS score was 17 (IQR 9.5-28); pre-procedural intravenous thrombolytic therapy was utilized in 29% of patients (92.5% received tPA), with 77.5% of procedures utilizing general anesthesia. The most used first-line MT technique included stand-alone aspiration catheters in 36.2% of the cases followed by a combination of SR+ADAPT in 29.7%, and eventual rescue stenting in 42.8% of cases. The median time from last-known-well to puncture time was 6 hours (IQR 3.8-13.2), with a median time from puncture-to-recanalization of 52 minutes (IQR 32-93). For distal lesions, a mean number of passes was 1.5±1.2, while for proximal lesions, endovascular revascularization was performed in 76.1% of cases, with a mean number of 1.3±0.8 of passes. Successful revascularization occurred in 88.4% of procedures. In terms of periprocedural complications, dissection occurred in 2.9%, vessel perforation 4.8%, and immediate vessel re-occlusion in 2.9% (requiring rescue stenting). Post-procedural symptomatic intracerebral hemorrhage occurred in 8% of the cases. Favorable clinical outcomes (90-day mRS 0-3) occurred in 44.2% of the patients, with a 32.6% mortality rate. Conclusion Mechanical thrombectomy for posterior circulation tandem occlusions is feasible with reasonable clinical outcomes, despite a high rate of rescue stenting. Disclosures M. Salem: None. G. Sioutas: None. M. Mohammaden: None. A. Luisa Kuhn: None. A. Luisa Kuhn: None. A. Luisa Kuhn: None. C. Tschoe: None. M. Tarek: None. A. Dmytriw: None. R. Regenhardt: None. S. Marioni: None. M. AbdalKader: None. G. Cortez: None. V. Srinivasan: None. T. Nguyen: None. S. Tjoumakaris: None. A. Puri: None. V. Pereira: None. J. Rabinov: None. J. Seigler: None. R. Hanel: None. S. Sheth: None. A. Siddiqui: None. E. Levy: None. D. Haussen: None. M. Lang: None. M. Lang: None. P. Kan: None. O. Tanweer: None. B. Gross: None. B. Gross: None. A. Thomas: None. T. Jovin: None. R. Nogueira: None. P. Jabbour: None. B. Jankowitz: None. J. Burkhardt: 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 | 0.001 | 0.002 |
| 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 | 0.001 |
| 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".