Endovascular Thrombectomy Combined with Decompressive Craniectomy for Malignant Anterior Circulation Large Vessel Occlusion Stroke: A Real-World Study
Bibliographic record
Abstract
OBJECTIVE: To evaluate the efficacy of endovascular thrombectomy (EVT) combined with decompressive craniectomy (DC) in patients with malignant anterior circulation large vessel occlusion (MACLVO) stroke. METHODS: We retrospectively analyzed clinical data from 189 MACLVO stroke patients who received EVT with or without DC. Outcomes included onset to treatment time, National Institutes of Health Stroke Scale (NIHSS) score, Alberta Stroke Program Early CT Scores, neurointensive care unit (NICU) stay, and 90-day modified Rankin Scale score. Univariate and multivariate logistic regressions were performed to identify predictors of mortality and prognosis. RESULTS: The EVT-DC group had significantly longer onset to treatment time, higher NIHSS, and lower Alberta Stroke Program Early CT Scores preoperatively. Despite no difference in total hospital stay, NICU duration was shorter in the EVT-DC group (11.89 ± 1.76 vs. 12.53 ± 2.06 days, P = 0.031). The 90-day mortality was significantly lower in the EVT-DC group (33.80% vs. 68.65%, P < 0.001). Although favorable outcomes among survivors were more common with EVT-DC (12.68% vs. 1.69%), the difference was not statistically significant (P = 0.064). Multivariate logistic regression analysis showed EVT combined with DC and preoperative NIHSS score were independent predictors of both mortality (odds ratio [OR = 1.614, P = 0.035; OR = 0.064, P < 0.001) and favorable prognosis (OR = 3.030, P = 0.049; OR = 0.004, P = 0.003). CONCLUSIONS: EVT combined with DC reduces mortality and NICU stay in MACLVO stroke, with a potential trend toward better functional outcomes. However, severe disability remains common, underscoring the need for shared decision-making with patients and families.
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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 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| 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".