Flow Diversion for the Treatment of Distal Circulation Aneurysms: A Randomized Comparison
Bibliographic record
Abstract
ABSTRACT BACKGROUND AND PURPOSE: Flow diversion (FD) has expanded beyond initial indications (proximal carotid artery aneurysms) to include distal circulation aneurysms (on the anterior, middle, or posterior cerebral arteries). Our objective was to examine results obtained from aneurysms in these locations in the Flow Diversion in the Treatment of Intracranial Aneurysms Trial (FIAT) which compared FD with alternative standard management options (ASMO). MATERIALS AND METHODS: FIAT was an all-inclusive parallel-group 1:1 randomized study comparing FD with one of 4 ASMOs (coiling +/-stenting, parent vessel occlusion (PVO), clipping, or observation, pre-specified by clinical judgment). The primary safety outcome was death or dependency (mRS >2) at 3 months. The composite primary outcome was “treatment failure,” defined as initial failure to treat the aneurysm; aneurysm rupture or retreatment during follow-up; death or dependency (mRS>2); or angiographic residual aneurysm adjudicated by independent core laboratory at 12 months. This subgroup analysis was not prespecified and there was no blinding. RESULTS: Of the 323 patients in FIAT, 46 (14%) with distal circulation aneurysms were randomly allocated: 23 to FD and 23 to ASMO (coiling +/-stenting (16 patients), PVO (1), clipping (3), and observation (3)). Death or dependency at 3 months occurred in one patient (allocated ASMO). Treatment failures occurred in 6/23 FD-treated patients (26.1%; 95%CI: 12.6%-46.5%) compared to 11/22 patients treated with ASMO (50.0%; 95%CI: 30.7%-69.3%; RR=0.52, [0.23-1.17]; P=0.13). Serious adverse events were similar. CONCLUSIONS: Distal circulation aneurysms treated with FDs in FIAT showed an encouraging trend, but this analysis was underpowered. Further randomized trials are needed. ABBREVIATIONS: ASMO = Alternative standard management options; FD = Flow Diversion; FIAT = Flow Diversion in the Treatment of Intracranial Aneurysms Trial; PVO = Parent Vessel Occlusion; mRS = modified Rankin Scale
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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 | 0.004 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.004 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.010 | 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".