Emergent Carotid Artery Stenting in Patients With Acute Ischemic Stroke With Tandem Lesions
Bibliographic record
Abstract
BACKGROUND AND OBJECTIVES: Management of carotid lesions during endovascular therapy (EVT) in patients with acute ischemic stroke (AIS) due to tandem lesions (TL) remains controversial, and long-term prognosis data are scarce. We evaluated 90-day and 1-year follow-up outcomes of emergent carotid artery stenting (eCAS) vs non-eCAS in these patients. METHODS: Data from a prospective mandatory population-based registry of Code Stroke in Catalonia (Spain) between 2017 and 2023 were analyzed. Patients with large vessel occlusion and ipsilateral ≥50% atheromatous cervical internal carotid artery (ICA) stenosis undergoing EVT were identified. eCAS and non-eCAS groups were compared. The primary outcome was the shift in the modified Rankin Scale (mRS) score at 90 days and 1 year of follow-up, adjusted using inverse probability of treatment weighting. Stratified analyses in predefined key subgroups according to sex, age, degree of ICA stenosis, Alberta Stroke Program Early CT Score, baseline NIH Stroke Scale, and previous IV thrombolysis were performed. Secondary outcomes included successful recanalization (modified Thrombolysis In Cerebral Infarction ≥2b), 90-day favorable functional outcome (mRS 0-2), hemorrhagic transformation (HT), and 90-day mortality. RESULTS: < 0.001). Potential treatment effect differences were observed for women and older patients. DISCUSSION: In this population-based study of patients with AIS due to TL, eCAS was associated with a better mid-term and long-term functional outcome without safety concerns, even in moderate ICA stenosis. Limitations include the observational design and possible unmeasured confounders. Further studies are needed to explore the mechanisms underlying the differential effects of eCAS in women and older patients. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that in patients with AIS and TL undergoing EVT, eCAS is associated with favorable functional outcome at 90 days compared with EVT alone.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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 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".