E-100 Intravenous thrombolysis in distal medium middle cerebral artery occlusion patients with unsuccessful mechanical reperfusion
Bibliographic record
Abstract
Background The efficacy and safety of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT) for distal, medium vessel occlusions (DMVO) is not well established. This study investigates whether IVT impacts outcomes in DMVO patients, particularly in those with unsuccessful or partial recanalization after MT. Methods We conducted a retrospective, multicenter study using data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry. The study population included acute ischemic stroke patients with DMVO in the M2, M3, and M4 segments of the MCA, treated with or without IVT followed by MT and a final modified Thrombolysis in Cerebral Infarction (mTICI) score of 0, 1, or 2a. The primary outcome was functional independence, assessed by the 90-day modified Rankin Scale (mRS) of 0–1 or 0–2. Results The study comprised 210 patients with final mTICI 0 to 2a, with 130 undergoing MT alone and 80 receiving IVT followed by MT (figure 1). Logistic regression analysis revealed no significant difference in clinical outcomes between groups, with odds ratios (ORs) for achieving a 90-day mRS of 0–1 and 0–2 being 1.13 (95% CI 0.52 to 2.45; p=0.75) and 1.09 (95% CI 0.57 to 2.07; p=0.79), respectively. The odds of symptomatic intracerebral hemorrhage (sICH) were similar between groups (OR 0.68, 95% CI 0.30 to 1.54; p=0.37), as were the odds of intracranial hemorrhage (ICH) of any type (OR 1.50, 95% CI 0.89 to 2.52; p=0.22) (figure 2). Conclusions In AIS patients with DMVO and unsuccessful or partial recanalization after MT, IVT did not significantly improve clinical outcomes. Additionally, IVT did not increase the risk of hemorrhagic complications. These findings suggest that while IVT is safe in this context, its may not improve outcomes for patients with unsuccessful MT. Disclosures S. Ghozy: None. A. Dmytriw: None. N. Cancelliere: None. V. Pereira: None. H. Salim: None. B. Musmar: None. R. Kadirvel: None. A. Guenego: 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 | 0.001 | 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 | 0.000 | 0.000 |
| 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".