Modified carotid artery balloon angioplasty technique for challenging tandem occlusions in acute stroke
Bibliographic record
Abstract
Tandem occlusion in the setting of acute ischemic stroke presents a challenge for endovascular thrombectomy, leading to delayed revascularization with associated poor prognosis and unfavorable outcomes. Simple angioplasty of the carotid stenosis does not always allow the guiding catheter to advance past the stenosis. We present a modified carotid angioplasty technique in which the guiding catheter can successfully be advanced through the carotid stenosis. This allows for faster recanalization and treatment of the intracranial occlusion, knowing that longer procedure times lead to worse outcome. During the modified angioplasty technique, the angioplasty balloon is positioned and inflated partially within the distal guiding catheter and partially within the carotid stenosis. This technique creates momentum for the guiding catheter to advance past the stenosis before it recollapses. Similar techniques have been described before to cross carotid stenosis with an aspiration catheter, and using a diagnostic catheter with a 0.035" wire, using the Dotter technique. However, with this technique it is the guide catheter which can be positioned beyond the proximal carotid stenosis, allowing for access to the intracranial circulation to perform as many thrombectomy passes as required. This allows for faster access to the occluded vessel, without the need for initial stenting, reducing the recanalization times in challenging tandem occlusion cases.
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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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".