Abstract TMP85: Endovascular Thrombectomy for Large Ischemic Strokes With Tandem Lesions: <i>A SELECT2 Subanalysis</i>
Bibliographic record
Abstract
Introduction: Trials evaluating thrombectomy (EVT) efficacy and safety in large vessel occlusion (LVO) excluded patients with cervical tandem lesions (TL). We aimed to evaluate EVT efficacy and safety in large stroke patients with TL from the SELECT2 trial. Methods: SELECT2 was a randomized controlled trial evaluating EVT vs. medical management (MM) in patients with LVO ischemic strokes (ASPECTS 3-5 on computed tomography (CT) or ischemic core ≥50 ml on CT Perfusion/MR diffusion-perfusion). TL were defined as internal carotid artery occlusion with a concomitant LVO as determined by the core lab. Functional, safety, and imaging outcomes were compared between patients in EVT vs. MM. Results: Of 352 enrolled, 100 (28%) had tandem occlusions, with 56 receiving EVT. ASPECTS (EVT: 4 [3-5] vs. MM: 4 [4-5]), ischemic core estimates (EVT: 86 [58-133] ml vs. MM: 81 [61-121] ml) and critically hypoperfused tissue volume (EVT: 185 [131-266] ml vs. MM: 192 [142-252] ml) were similar between groups. TL Patients receiving EVT demonstrated significantly better functional outcomes (mRS at 90d: EVT 4[3-6] vs MM 5[4-6]; aGenOR: 2.22; 95%CI, 1.47-3.34; p<0.001), similar to those without TL (aGenOR: 1.59, 95% CI: 1.23-2.05, p<0.001; P-int-0.29) and a higher proportion of patients achieving functional independence (EVT: 20% vs. MM: 2%; aRR: 9.53; 95%CI, 1.71-53.21; p=0.010) and independent ambulation (EVT: 38% vs MM: 11%; aRR: 3.60; 95%CI, 1.68-7.67; p=0.001), with significantly reduced complete dependence or death (mRS 5-6) (aRR: 0.66 (0.48-0.90), p=0.009). There was no difference in symptomatic ICH (EVT: 2% vs MM: 0%) or parenchymal hemorrhage (EVT: 2% vs MM: 0%). Complications occurred in 10 (18%) patients receiving EVT. In the EVT group, successful reperfusion (mTICI 2b-3) was associated with better functional outcome (aGenOR: 2.30; 95%CI, 1.14-4.65; p=0.021). Conclusion: In patients with tandem lesions, EVT and successful reperfusion were associated with better functional outcomes. Frequency of vascular complications was similar to those without tandem lesions and no patients receiving immediate stenting demonstrated parenchymal hemorrhage. Our findings support consideration of EVT in patients with tandem lesions with large ischemic strokes. NCT03876457
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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 | 0.003 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.003 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 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".