The reality of a real-world stroke patient – extended time window, low ASPECTS, and a good outcome
Bibliographic record
Abstract
Mechanical thrombectomy (MT) is recommended in patients with anterior large vessel occlusion from 6 to 24 hours after stroke onset in selected patients with baseline ischemia defined by Alberta stroke program early CT score (ASPECTS) ≥ 6.Recent studies have shown that carefully selected patients with lower ASPECTS 3-5 and even with ASPECTS 0-2 could benefit from MT.A 45-year-old patient was admitted to our emergency department 14 hours after the stroke onset.The neurological assessment revealed severe dysarthria, gaze palsy to the right, and severe left arm and leg palsy.His National Institutes of Health Stroke Scale (NIHSS) score was 10.The emergent brain CT scan showed large right middle cerebral artery territory infarction with right internal carotid artery and right M2 segment occlusion on CT angiography.The ASPECTS was 2. CT perfusion showed a good core/penumbra mismatch ratio in temporal/peri-insular parts and basal ganglia.The MT was performed 14 hours after the stroke onset with a TICI 2b score.The treatment was complicated by the progression of severe brain edema and brain herniation which required emergent decompressive craniectomy.The patient was discharged to the neurorehabilitation center after 26 hospital days with an NIHSS 10.On the last outpatient visit, after three months, the patient scored 5 on NIHHS and 3 on the 3-month Modified Rankin Score.Our patient was successfully treated by MT despite a low ASPECTS and extended time window.Further randomized control trials are necessary to define which subgroup of these patients can benefit from MT.
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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 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| 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 | 0.001 |
| 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".