O-062 Association of admission hyperglycemia with symptomatic intracranial hemorrhage among patients receiving tenecteplase versus alteplase before stroke thrombectomy
Bibliographic record
Abstract
Background and Purpose Admission hyperglycemia is an independent predictor of poor functional outcome in acute ischemic stroke. Stroke thrombolysis with alteplase (TPA) among patients with admission hyperglycemia is associated with increased risk of symptomatic intracranial hemorrahge (sICH) and decreased recanalization rates. Lately, tenecteplase (TNK) has been established as a non-inferior alternative to TPA in acute ischemic stroke care. The impact of admission hyperglycemia in TNK compared to TPA prior to large vessel occlusion (LVO) stroke thrombectomy requires further investigation. Methods LVO stroke patients who received intravenous thrombolysis with TPA or TNK before endovascular treatment were retrospectively reviewed. During the study period 01/2020 - 06/2023, the authors’ stroke-systems switched from TPA to TNK as their primary thrombolytic. Of consecutive 569 patients, 476 met inclusion criteria: proximal LVO, pre-stroke modified Rankin Scale (mRS) < 3, last-known-well to intravenous thrombolysis (LKW-to-IVT) ≤ 4.5 hours. Admission hyperglycemia was defined as ≥ 140 mg/dl and sICH as parenchymal hemorrhage associated with neurological decline of National Institute of Health Stroke Scale (NIHSS) ≥ 4. Multivariate logistic analysis was performed. Results Among 476 patients, 261 (54.8%) received TNK and 215 (45.2%) TPA prior to EVT. The site of occlusion was the M1 middle cerebral artery (MCA) (45.6%), M2 MCA (27.9%), internal carotid artery (14.3%), tandem carotid with M1 or M2 MCA (9.5%) and basilar artery (2.7%). Baseline demographics (age, sex, NIHSS, LKW-to-IVT, Alberta Stroke Program Early CT Score) and admission hyperglecmia rates (TNK 32.8% and TPA 33.5%) were comparable. Admission hyperglycemia was significantly associated with sICH (area under the curve 0.71, 95% CI 0.66 - 0.75, p=0.003). In multivariate analysis, admission hyperglycemia remained independently associated with sICH (adjusted odds ratio 3.9, 95% CI 1.3 - 12.0, p=0.017). Admission hyperglycemia effects were similar in TNK compared to TPA groups. Conclusions Among LVO stroke patients receiving intravenous thrombolysis prior to EVT, admission hyperglycemia is significantly associated with risk of sICH. The detrimental effects of admission hyperglycemia were similar with TNK compared to TPA prior to EVT. Disclosures P. Hendrix: None. P. Koul: None. C. Schirmer: None. M. Lang: None. A. Al-Bayati: None. R. Nogueira: None. B. Gross: 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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 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 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".