Effect of thrombolysis type on the efficacy of aspiration versus stent retriever first line thrombectomy: results from the AcT trial
Bibliographic record
Abstract
BACKGROUND: Intravenous (IV) tenecteplase is increasingly being used in lieu of alteplase for acute ischemic stroke. We sought to study the influence of IV tenecteplase versus IV alteplase on the efficacy of first line thrombectomy strategy. METHODS: This was a secondary analysis of the Alteplase versus Tenecteplase (AcT) trial. We included anterior and posterior circulation stroke patients in whom a thrombectomy was attempted. We compared outcomes for stent retriever as first line strategy versus contact aspiration alone, and interactions with thrombolysis type. We examined angiographic outcomes (extended final thrombolysis in cerebral infarction (eTICI) 2c-3 after first-pass, eTICI 2b-3 and eTICI 2 c-3 on final angiography), and clinical and safety outcomes. Mixed effect regression analyses with interaction terms were performed. All outcomes were assessed and analyzed by blinded adjudicators. RESULTS: Among 506 patients who received thrombectomy, 435 were included (222 (51.0%) IV tenecteplase, 213 (49.0%) IV alteplase). A stent retriever was used as the first line endovascular thrombectomy (EVT) approach in 288 (66.2%), and aspiration in 147 (33.8%) patients. There was no difference in rates of final eTICI 2c-3 between groups (57.0% with stent retriever vs 61.9% with aspiration; P=0.35). There was, however, a significant interaction (P=0.02) between thrombolysis type and first line EVT strategy for final eTICI 2c-3, where tenecteplase was associated with higher odds of final eTICI 2c-3 with aspiration (adjusted OR (aOR) 2.29, 95% CI 1.10 to 4.75), but not with stent retriever (aOR 0.63, 95% CI 0.38 to 1.04). No significant interaction between thrombolysis and first line strategy was found for the other angiographic, clinical or safety outcomes. CONCLUSION: IV tenecteplase before EVT may enhance reperfusion with first line aspiration. TRIAL REGISTRATION NUMBER: NCT03889249.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".