Venous return index after mechanical thrombectomy predicts parenchymal hemorrhage and poor outcomes
Bibliographic record
Abstract
BACKGROUND AND PURPOSE: The significance of early venous filling on digital subtraction angiography (DSA) after mechanical thrombectomy (MT) is unclear. This study introduces the Venous Return Index (VRI) to explore the relationship between VRI in different intracranial veins and outcomes after MT in acute anterior circulation large vessel occlusion (AC-LVO) stroke. METHODS: A retrospective analysis of AC-LVO stroke patients who underwent successful MT (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2b) within 24 hours from April 2014 to March 2023 was conducted. VRI, defined as the relative appearance time of the target vein on DSA, was analyzed for 8 intracranial veins (vein of Trolard, superficial middle cerebral vein, sphenoparietal sinus, vein of Labbé, thalamostriate vein, internal cerebral vein, vein of Galen, and basal vein). The definition of parenchymal hemorrhage (PH) follows the ECASS (European Cooperative Acute Stroke Study) standard. An unfavorable outcome is defined as a 90-day modified Rankin Scale (mRS) score of 4-6. The study assessed the relationship between VRI and 24-hour PH as well as 90-day mRS. RESULTS: A total of 432 patients were included, with 22.5% experiencing PH and 42.4% having poor outcomes (mRS 4-6). The thalamostriate, internal cerebral, and great cerebral veins were independently associated with 24-hour PH and 90-day poor outcomes. The Alberta stroke program early CT score - blood Glucose -Thrombectomy attempts - Venous index (AGTV) scale, incorporating VRI from these veins, was developed to predict PH risk, with an area under the curve (AUC) of 0.887. The PH risk was 50.5% for AGTV ≥6 and 14.1% for AGTV <6. CONCLUSIONS: VRI in the thalamostriate, internal cerebral, and Galen veins was independently associated with 24-hour PH and 90-day poor outcomes. The AGTV scale effectively predicts PH risk after MT.
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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 | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| 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".