Abstract TP249: Atrial Fibrillation Is Associated With Lower Likelihood Of First Pass Effect In Thrombectomy For Medium Vessel Occlusion Acute Ischemic Stroke
Bibliographic record
Abstract
Introduction: First pass effect (FPE) in endovascular thrombectomy (EVT) is associated with favorable treatment course and recovery, making it an important prognostic indicator for patients undergoing EVT. Atrial fibrillation (AF) related strokes have been shown to be associated with greater rates of FPE in acute large vessel occlusions; however, the association between AF and FPE in medium vessel occlusions (MeVO) is unknown. We aimed to assess the association between AF and achieving FPE in MeVO. Methods: A prospectively-maintained retrospective registry of adult acute ischemic stroke patients was retrospectively reviewed (10/2019-10/2023). Patients undergoing EVT for a MeVO in a middle cerebral artery segment (M2/M3) were included. Multivariable logistic regressions with 2500 bootstrap iterations for modified FPE (mFPE, defined as modified Treatment in Cerebral Infarction [mTICI] 2B/2C/3) and FPE (mTICI 2C/3) was performed using the following covariables: age, sex, comorbid conditions, anticoagulation/antiplatelet use, premorbid modified Rankin score, admission National Institutes of Health Stroke Scale, Alberta Stroke Program Early Computed Tomography Score, occlusion location and laterality, thrombolytic administration, and EVT approach (either aspiration-only or combination aspiration with stent retriever). Receiver operator characteristics curve analysis was performed to derive area under the curve (AUC) to assess model performance. Results: Of 67 patients included, median age was 70 years (IQR 63-82). Most occlusions were in the distal M2 segment (88.1%). Rate of mFPE was 58.2% (39/67); rate of FPE was 34.3% (23/67). In multivariable regressions, AF (adjusted OR 0.04, 95% CI 0.01-0.49, p=0.01) and lack of antiplatelet/anticoagulant use (adjusted OR 0.05, 95% CI 0.01-0.71, p=0.03) were independently associated with lower likelihood of mFPE. AF was the only covariable significantly associated with lower odds of FPE (adjusted OR 0.08, 95% CI 0.01-0.63, p=0.02). Models for mFPE and FPE had AUCs of 0.86 (95% CI 0.78-0.94) and 0.80 (0.75-0.85), respectively. Conclusion: AF was associated with a significantly lower likelihood of FPE and mFPE in thrombectomy for MeVOs. This may suggest a need to prepare for additional passes and rescue intraprocedural strategies in EVT for MeVO patients with AF. Future studies are needed to further investigate this relationship.
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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 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| 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 | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 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".