E-045 Second line thrombectomy technique following an unsuccessful first pass thrombectomy for anterior circulation large vessel occlusion stroke: to switch or not to switch?
Bibliographic record
Abstract
Introduction Despite comparable outcomes for different frontline techniques in mechanical thrombectomy (MT) for acute ischemic stroke (AIS), there are sparse data regarding if and when to switch techniques if the first-pass MT is unsuccessful. We investigated the converting from one MT technique to another on the second MT attempt for AIS among patients with anterior circulation large vessel occlusion (LVO). Methods This was a retrospective observational study using data from the large multicenter international ‘anonymous’. Data from 29 stroke centers for 10,229 patients between January 2010 and December 2022 was investigated. The primary outcome measure was successful recanalization defined as a modified Thrombolysis in Cerebral Ischemia score ≥2b. 90-day modified Rankin score (mRS) 0–2, mortality and symptomatic hemorrhage were used as secondary outcomes. Clinical and technical outcomes after the second MT attempt were compared between those with or without technique conversion. Results 1,797 patients with unsuccessful first-pass MT were included in this analysis. Converting to alternative techniques following an unsuccessful first-pass MT was more likely to be associated with successful recanalization at the second attempt (adjusted odds ratio 2.30, 95% CI: 1.37–3.86, P = 0.002) and 90-day good clinical outcome (adjusted odds ratio 2.10, 95% CI: 1.15–3.85, P = 0.02) after multivariate adjustment. Conclusions This study demonstrates better clinical and technical outcomes with the conversion of the MT technique for the second attempt in AIS patients with anterior circulation LVO and an unsuccessful first-pass MT. Disclosures H. Matsukawa: 2; C; B. Braun. 3; C; Daiichi-Sankyo, Stryker. K. Uchida: 3; C; Daiichi-Sankyo, Bristol-Myers Squibb, Stryker, Medtronic. A. Alawieh: None. C. Matouk: 1; C; Contact PI for NIH Grant R21NS128641. . 2; C; Stryker, Medtronic, Microvention, Penumbra, and Silk Road Medical. 3; C; Speaker for Penumbra and Silk Road Medical. S. Al Kasab: None. M. Sowlat: None. S. Elawady: None. R. Abo Kasem: None. J. Isidor: None. I. Maier: 3; C; speakers honoraria from Pfizer and Bristol-Myers Squibb. P. Jabbour: None. J. Kim: None. S. Quintero Wolfe: None. A. Rai: None. R. M Starke: 1; C; RMS research is supported by the NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, Department of Health Biomedical Research Grant (21K02AWD-007000) and by National Institute of H, RMS has an unrestricted research grant from Medtronic and Balt and has consulting and teaching agreements with Penumbra, Abbott, Medtronic, Balt, InNeuroCo, Cerenovus, Naglreiter, Tonbridge, Von Medic. M. Psychogios: 1; C; Grants from the Swiss National Science Foundation (SNF) for the DISTAL trial (33IC30_198783) and TECNO trial (32003B_204977), Grant from Bangerter-Rhyner Stiftung for the DISTAL trial. Unrestricted Gr. 3; C; Speaker fees: Stryker Neurovascular Inc., Medtronic Inc., Penumbra Inc., Acandis GmbH, Phenox GmbH, Siemens Healthineers AG. E. Samaniego: 2; C; consults for Medtronic, microvention, Rapid Medical. H. Cuellar: 2; C; Consultant for Medtronic and Microvention. B. Howard: None. D. Romano: 2; C; Penumbra, Balt, Microvention, Phenox. O. Tanweer: 1; C; Educational/Research Grants: Q’apel Inc, Steinberg Foundation. 2; C; Consulting Agreements: Viz.AI, Inc., Penumbra, Inc, Balt, Inc, Stryker Inc, Imperative Inc. J. Mascitelli: None. I. Fragata: None. J. Osbun: None. R. Crosa: None. M. S. Park: 2; C; Consultant for Medtronic. M. R. Levitt: 1; C; Unrestricted educational grants from Medtronic and Stryker;. 2; C; consulting agreement with Medtronic, Aeaean Advisers and Metis Innovative. 6; C; equity interest in Proprio, Stroke Diagnostics, Apertur, Stereotaxis, Fluid Biomed, and Hyperion Surgical; editorial board of Journal of NeuroInterventional Surgery; Data safety monitoring board of Ar. W. Brinjikji: 2; C; He receives consulting fees from Medtronic, Stryker, Imperative Care, Microvention, MIVI Neurovascular, Cerenovus, Asahi, and Balt. 6; C; Holds equity in Nested Knowledge, Superior Medical Editors, Piraeus Medical, Sonoris Medical, and MIVI Neurovascular. He receives royalties from Medtronic and Balloon Guide Catheter Technology, He serves in a leadership or fiduciary role for MIVI Neurovascular, Marblehead Medical LLC, Interventional Neuroradiology (Editor in Chief), Piraeus Medical, and WFITN. M. Moss: None. T. Dumont: None. R. Williamson Jr: 2; C; Consultant for Medtronic, Stryker, and Synaptive Medical. P. Navia: 2; C; Consultant for Penumbra, Medtronic, Stryker, Cerenovus and Balt. P. Kan: 1; C; Grants from the NIH (1U18EB029353–01) and unrestricted educational grants from Medtronic and Siemens. Consultant for Imperative Care and Stryker Neurovascular. 4; C; Stock ownership in Vena Medical. R. De Leacy: 1; C; PI for Imperative Trial; Research grants from Siemens Healthineers and Kaneka medical. 2; C; Consultant for Cerenovus, Stryker Neurovascular and Sim & Cure. 6; C; Minor equity interest Vastrax, Borvo medical, Synchron, Endostream, Von Vascular, Radical catheters and Precision Recovery Inc. S. Chowdhry: 2; C; Consultant and proctor for Medtronic and Microvention. M. Ezzeldin: 2; C; Consultant for Viz.ai and Imperative care. 4; C; Investments in Galaxy Therapeutics. S. Yoshimura: 6; C; lecture fee from Stryker, Medtronic, Johnson & Johnson, Kaneka Medics. A. Spiotta: 2; C; Consultant for Penumbra, Terumo, RapidAI, Cerenovus.
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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 | 0.003 |
| 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 | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 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".