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Record W4407172794 · doi:10.1056/nejmoa2411668

Endovascular Treatment of Stroke Due to Medium-Vessel Occlusion

2025· article· en· W4407172794 on OpenAlexafffundabout
Mayank Goyal, Johanna M. Ospel, Aravind Ganesh, Dar Dowlatshahi, David Volders, Markus Möhlenbruch, Mouhammad Jumaa, Shahid M. Nimjee, Thomas C. Booth, Brian Buck, James Kennedy, Jai Shankar, Franziska Dorn, Liqun Zhang, Christian Hametner, Sándor Nardai, Atif Zafar, William K. Diprose, Shabnam Vatanpour, Alexander Stebner, Salome Bosshart, Nishita Singh, Ivy Sebastian, Kazutaka Uchida, Karla J. Ryckborst, Robert Fahed, Sherry Hu, Dominik F. Vollherbst, Syed Zaidi, Vivien Lee, Jeremy Lynch, Jeremy Rempel, Rachel Teal, Anurag Trivedi, Felix J. Bode, Ayokunle Ogungbemi, Mirko Pham, Péter Orosz, Mohamad Abdalkader, Christian Taschner, Jason Tarpley, Sven Poli, Ravinder‐Jeet Singh, Reade De Leacy, George Α. Lopez, Demetrios J. Sahlas, Michael Chen, Paul Burns, Joanna D. Schaafsma, Richard Marigold, Arno Reich, Adewumi Amole, Thalia S. Field, Richard H. Swartz, Fabio Settecase, Gábor Lenzsér, Santiago Ortega‐Gutiérrez, Negar Asdaghi, Kyriakos Lobotesis, Adnan H. Siddiqui, J. Berrouschot, Maxim Mokin, Koji Ebersole, Hauke Schneider, Albert J. Yoo, Jennifer Mandzia, Jesse Klostranec, Changez Jadun, Tufail Patankar, Eric Sauvageau, Robert Lenthall, Lissa Peeling, Thien Huynh, Ronald F. Budzik, Seon-Kyu Lee, Levansri Makalanda, Michael R. Levitt, Richard Perry, Thant Hlaing, Babak S. Jahromi, Paul Singh, Andrew M. Demchuk, Michael D. Hill

Bibliographic record

VenueNew England Journal of Medicine · 2025
Typearticle
Languageen
FieldMedicine
TopicAcute Ischemic Stroke Management
Canadian institutionsMontreal Neurological Institute and HospitalRoyal University HospitalWestern UniversityUniversity of TorontoUniversity of British ColumbiaMcMaster UniversityNOSM UniversityHealth Sciences CentreUniversity Health NetworkOttawa HospitalUniversity of Alberta HospitalSunnybrook Health Science CentreSt. Michael's HospitalUniversity of ManitobaDalhousie UniversityUniversity of OttawaUniversity of AlbertaUniversity of Calgary
FundersCanadian Institutes of Health ResearchUniversity of Calgary
KeywordsEndovascular treatmentOcclusionStroke (engine)MedicineRadiologyCardiologyEngineeringAneurysmMechanical engineering

Abstract

fetched live from OpenAlex

BACKGROUND: Whether the large effect size of endovascular thrombectomy (EVT) for stroke due to large-vessel occlusion applies to stroke due to medium-vessel occlusion is unclear. METHODS: In a multicenter, prospective, randomized, open-label trial with blinded outcome evaluation, we assigned patients with acute ischemic stroke due to medium-vessel occlusion who presented within 12 hours from the time that they were last known to be well and who had favorable baseline noninvasive brain imaging to receive EVT plus usual care or usual care alone. The primary outcome was the modified Rankin scale score (range, 0 [no symptoms] to 6 [death]) at 90 days, reported as the percentage of patients with a score of 0 or 1. RESULTS: A total of 530 patients from five countries were enrolled between April 2022 and June 2024, with 255 patients assigned to the EVT group and 275 to the usual-care group. Most patients (84.7%) had primary occlusions in a middle-cerebral-artery branch. A modified Rankin scale score of 0 or 1 at 90 days occurred in 106 of 255 patients (41.6%) in the EVT group and in 118 of 274 (43.1%) in the usual-care group (adjusted rate ratio, 0.95; 95% confidence interval [CI], 0.79 to 1.15; P = 0.61). Mortality at 90 days was 13.3% in the EVT group and 8.4% in the usual-care group (adjusted hazard ratio, 1.82; 95% CI, 1.06 to 3.12). Symptomatic intracranial hemorrhage occurred in 14 of 257 patients (5.4%) in the EVT group and in 6 of 272 (2.2%) in the usual-care group. CONCLUSIONS: Endovascular treatment for acute ischemic stroke due to medium-vessel occlusion within 12 hours did not lead to better outcomes at 90 days than usual care. (Funded by the Canadian Institutes for Health Research and Medtronic; ESCAPE-MeVO ClinicalTrials.gov number, NCT05151172.).

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.

How this classification was reachedexpand

Full frame distilled prediction

Teacher imitation

Not 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.

metaresearch head score (Codex)0.001
metaresearch head score (Gemma)0.000
Version: codex-gemma-dda1882f352aValidation status: machine_predicted_unvalidated
Candidate categoriesnone
Consensus categoriesnone
DomainCandidate signal: none · Consensus signal: none
Study designCandidate signal: Not applicable · Consensus signal: none
GenreCandidate signal: Empirical · Consensus signal: Empirical
Teacher disagreement score0.523
Threshold uncertainty score0.504

Codex and Gemma teacher scores by category

CategoryCodexGemma
Metaresearch0.0010.000
Meta-epidemiology (narrow)0.0000.000
Meta-epidemiology (broad)0.0010.000
Bibliometrics0.0010.000
Science and technology studies0.0000.000
Scholarly communication0.0000.000
Open science0.0000.000
Research integrity0.0000.000
Insufficient payload (model declined to judge)0.0000.000

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.

Opus teacher head0.012
GPT teacher head0.279
Teacher spread0.267 · how far apart the two teachers sit on this one work
Validation statusscore_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it

Classification

machine, unvalidated

Machine predicted; a candidate call from one teacher head, not a consensus.

The models applied no category: nothing in the taxonomy fit this work.
Study designNot applicable
Domainnot available
GenreEmpirical

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".

Quick stats

Citations213
Published2025
Admission routes3
Has abstractyes

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