E-063 Number of passes in mechanical thrombectomy matters in patients with large vessel occlusion presenting with low aspects score
Bibliographic record
Abstract
Introduction Real-world data showed that less than half of the acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) presenting with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS) (2–5) achieved favorable outcomes at 90 days after mechanical thrombectomy (MT). In this study, we aim to investigate the relationship between the number of MT passes at which successful recanalization is obtained and outcomes in LVO-related AIS patients with low ASPECTS. Methods This retrospective cohort study was performed on the data from 31 thrombectomy-capable centers between 2013 to 2022. Successful recanalization was defined as modified Thrombolysis in Cerebral Ischemia Score ≥ 2b. The primary outcome was a 90-day modified Rankin Scale (mRS) of 0–3. Secondary outcomes were symptomatic intracranial hemorrhage and intracranial hemorrhage within 24 hours and mortality at 90 days. Outcomes were compared among patients with unsuccessful recanalization, successful recanalization at first, second, third, and more than four passes. Results A total of 297 patients with a median age of 70 [IQR 59–78] years were included and 140 (47.1%) were female. In 239 (80.4%) patients, successful recanalization was achieved: 88 patients (29.6%) with 1 pass, 59 patients (19.9%) with 2 passes, 35 (11.8%) patients with 3 passes (11.8%), and 57 patients (19.2%) with more than 4 passes. Compared to unsuccessful recanalization, successful recanalization at first pass (adjusted OR 5.25, 95% CI 1.78 - 17.1), second passes (adjusted OR 5.20, 95% CI 1.68 - 17.6), and passes 4 (adjusted OR 4.90, 95% CI 1.68 - 17.6) was related to 90-day mRS 0–3. Recanalization status and MT attempt number were not related to secondary outcomes except for 90-day mortality. Compared to unsuccessful recanalization, successful recanalization at second and third passes were inversely related to 90-day mortality (adjusted OR 0.37, 95% CI 0.14 - 0.93; adjusted OR 0.33, 95% CI 0.11 - 0.95, respectively). Conclusion The present results indicated that successful recanalization was related to 90-day good outcome regardless the number of MT passes but the odds of achieving favorable outcome declined with each pass. Disclosures M. Sowlat: None. S. Samir Elawady: None. H. Matsukawa: 2; C; B. Braun. 6; C; Daiichi-Sankyo, Stryker. J. Isidor: None. C. Cunningham: None. R. Abo Kasem: None. A. Orscelik: None. I. Maier: 6; C; Pfizer, Bristol-Myers Squibb. P. Jabbour: None. J. Kim: None. S. Quintero Wolfe: None. A. Rai: None. R. M Starke: 1; C; NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, Department of Health Biomedical Research Grant (21K02AWD-007000) and by National Institute of Health (R01NS111119–01A1) and (UL1, Medtronic and Balt. 2; C; Penumbra, Abbott, Medtronic, Balt, InNeuroCo, Cerenovus, Naglreiter, Tonbridge, Von Medical, and Optimize Vascular. M. Psychogios: 1; C; 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, Stryker Neurovascular Inc., Phenox GmbH, Penumbra Inc. and Rapid Medical Inc., Sponsor-PI SPINNERS trial (Funded by a Siemens Healthineers AG Grant). 3; C; Stryker Neurovascular Inc., Medtronic Inc., Penumbra Inc., Acandis GmbH, Phenox GmbH, Siemens Healthineers AG. 6; C; Siemens Healthineers AG, Local PI for the ASSIST, EXCELLENT, TENSION, COATING, SURF and ESCAPE-NEXT trials. E. A Samaniego: 2; C; Medtronic, microvention, Rapid Medical. N. Goyal: None. S. Yoshimura: 6; C; Stryker, Medtronic, Johnson & Johnson, Kaneka Medics. H. Cuellar: 2; C; Medtronic and Microvention. J. A. Grossberg: 2; C; Cognition, Imperative Care. 6; C; Georgia Research Alliance, Emory Medical Care Foundation, Neurosurgery Catalyst. A. Alawieh: None. A. Alaraj: 2; C; Cerenovus. M. Ezzeldin: 2; C; Viz.ai and Imperative care. 4; C; Galaxy Therapeutics. D. G. Romano: 2; C; Penumbra, Balt, Microvention, Phenox. O. Tanweer: 1; C; Q’apel Inc, Steinberg Foundation. 2; C; Viz.AI, Inc., Penumbra, Inc, Balt, Inc, Stryker Inc, Imperative Inc. 6; C; Microvention Inc, Medtronic Inc. J. Mascitelli: None. I. Fragata: None. A. Polifka: None. F. Siddiqui: None. J. Osbun: None. R. Grandhi: 2; C; Balt Neurovascular, Cerenovus, Medtronic Neurovascular, Rapid Medical, and Stryker Neurovascular. R. Crosa: None. C. Matouk: 2; C; Stryker, Medtronic, Microvention, Penumbra, and Silk Road Medical. 3; C; Penumbra and Silk Road Medical. M. S. Park: 2; C; Medtronic. M. R. Levitt: 1; C; Medtronic and Stryker. 2; C; Medtronic, Aeaean Advisers and Metis Innovative. 6; C; Proprio, Stroke Diagnostics, Apertur, Stereotaxis, Fluid Biomed, and Hyperion Surgical, editorial board of Journal of NeuroInterventional Surgery; Data safety monitoring board of Arsenal Medical. W. Brinjikji: 2; C; 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. E. Daglioglu: None. R. Williamson Jr.: 2; C; Medtronic, Stryker, and Synaptive Medical. P. Navia: 2; C; Penumbra, Medtronic, Stryker, Cerenovus and Balt. P. Kan: 1; C; Grants from the NIH (1U18EB029353–01) and unrestricted educational grants from Medtronic and Siemens. 2; C; Imperative Care and Stryker Neurovascular. 4; C; Vena Medical. R. De Leacy: 1; C; Research grants from Siemens Healthineers and Kaneka medical. 2; C; Cerenovus, Stryker Neurovascular and Sim & Cure. 6; C; Minor equity interest Vastrax, Borvo medical, Synchron, Endostream, Von Vascular, Radical catheters and Precision Recovery Inc., PI for Imperative Trial. S. Chowdhry: 2; C; Medtronic, Microvention. D. J Altschul: 2; C; MicroVention, Stryker, and Cerenovus. A. M. Spiotta: 2; C; 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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 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 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 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".