Abstract TP218: Prevalence, Characteristics, and Recurrent Event Risk of Cerebrovascular Fibromuscular Dysplasia in Patients with Ischemic Stroke or Transient Ischemic Attack– A Population-level Study
Bibliographic record
Abstract
Introduction: Fibromuscular dysplasia (FMD) is a rare, nonatherosclerotic, non-inflammatory vasculopathy for which only limited population-level data are available. We aimed to evaluate the prevalence and characteristics of cerebrovascular fibromuscular dysplasia (cFMD) in a population-level cohort of patients with ischemic stroke(IS) and transient ischemic attack (TIA). Methods: We studied a population-level cohort of all patients diagnosed with IS/TIA in an entire Canadian province (Alberta) from April 1, 2016, to March 31, 2017, followed for at least 5 years until March 31,2022 for recurrent IS/TIA using administrative health data. We used overlapping approaches of direct neuroimaging review as well as keyword searches (FMD, tortuosity, string of beads, and medial fibroplasia) of radiologist reports to identify cases of suspected cFMD. Following confirmatory review of neurovascular imaging by at least two readers, relevant data on clinical characteristics, risk factor profile, tortuosity index, and anatomical extent of the vascular disease were ascertained from imaging review and clinical records. The 5-year risk of recurrent events was estimated using logistic regression adjusted for age, sex and vascular risk factors. Results: Among 7,745 patients with IS/TIA found 34 cases of cFMD in the cohort, accounting for a population prevalence of 0.44% or 439/100,000 cases of IS/TIA. Patients with cFMD were similar in age to those without (median age: 74 years, IQR:60-84 vs 71, IQR:60-82, p=0.52) and had similar vascular risk factors ( Table 1 ) but were significantly more likely to be female (79.4% vs 48.3%, p<0.001). The median NIHSS was 1.5 (IQR:1-4). The most frequent pattern of vascular involvement was extracranial proximal internal carotid artery with involvement of multiple vascular beds. Twenty-seven (81.8%) FMD cases had tortuous vessels on CT angiogram. Concomitant intracranial or extracranial aneurysms were detected in 9.1% (Table 2 ). 5year mortality following the index event was 29.4% and recurrent IS or TIA occurred in 23.5% of the patients by 5 years; this was not significantly higher than patients without FMD (aOR=1.7 95%CI:0.8-3.9). Conclusions: cFMD is a rare finding in patients with IS/TIA and mostly affects females and the extracranial proximal ICA. Whereas these patients had substantial rates of recurrent IS/TIA and mortality, this was not significantly higher than patients without FMD. Our findings merit further validation in larger cohorts of FMD.
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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 | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| 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".