P-020 Low ASPECTS thrombectomy: a meta-analysis of six randomized trials
Bibliographic record
Abstract
Background Six randomized controlled trials have concluded their investigations on the efficacy and safety of EVT for patients with large infarcts. Methods Study and patient characteristics of the RESCUE-Japan LIMIT, ANGEL-ASPECT, SELECT2, TESLA, TENSION, and LASTE trials were collected, and 90-day modified Rankin Scale (mRS) outcomes were tabulated. Generalized odds ratios (OR) of mRS shift and utilityweighted mRS (UW-mRS) values were calculated for each study. Random effects models were used to pool study outcomes. Results 922 patients received EVT, and 924 received medical management. Most patients had Alberta Stroke Program Early CT (ASPECT) scores of 3 to 5 and intracranial occlusion in the internal carotid artery (ICA) or the first segment of the middle cerebral artery (M1). EVT was significantly superior to medical management in terms of likelihoods of better mRS, functional independence (mRS 0–2), and independent walking (mRS 0–3) at 90 days, representing numbers needed to treat of 4.7 [95%CI 3.7 to 6.6], 7.1 [95%CI 5.6 to 9.6], and 10.6 [95%CI 8.2 to 14.8], respectively. EVT was not significantly associated with higher risk of symptomatic intracranial hemorrhage (+1.7% [95%CI -0.32% to +3.72%], p=0.10). There was significant inter-study heterogeneity in terms of mortality risk, which may have been due to differences in treatment time windows. Conclusions This study provides strong evidence that EVT is effective for patients presenting within 6 hours of stroke onset, ASPECT scores of 3 to 5, and intracranial ICA or proximal M1 occlusion. EVT beyond 6 hours or for more distal occlusions require further investigation. Disclosures H. Chen: None. M. Colasurdo: 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 | 0.012 | 0.019 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.027 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 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".