Influence of recent randomized MeVO trials on current practice patterns and future role of MeVO thrombectomy
Bibliographic record
Abstract
Introduction Numerous non-randomized studies suggest the benefit of endovascular thrombectomy (EVT) for medium vessel occlusion (MeVO) stroke, while recent randomized trials showed no benefit. In clinical practice, MeVO management remains heterogeneous. We gauged the current status quo of endovascular MeVO management and physicians’ perspectives on future MeVO-EVT trials. Methods International, cross-sectional survey study inquiring about practice patterns before and after publication of the MeVO trials, opinions on the design of second-generation MeVO trials, willingness to enroll in such trials, and personal opinions regarding optimal MeVO treatment strategies. Participants’ anonymized responses were summarized using descriptive statistics. Results Four hundred fifty-six physicians responded to the survey (308 China, 55 North America, 48 Europe, and 45 other countries). 86/454 (18.9%) respondents reported treating more MeVOs with EVT since the recent MeVO-EVT trials, and 134/454 (29.5%) reported treating fewer. Four-hundred-sixteen of 454 (91.6%) reported that their willingness to enroll patients in a second-generation MeVO-EVT trial increased (282/454 [62.1%]) or remained the same (134/454 [29.5%]) compared to before the recent trial publications. Of 122/454 (26.9%) respondents who participated in a MeVO-EVT trial, 79/121 (65.3%) stated that enrolment bias occurred at their sites. Three hundred twelve of 454 (68.7%) respondents (271/378 [71.7%] interventionalists, 41/76 [53.9%] non-interventionalists, p = 0.004) expressed belief in EVT benefit despite the neutral trial results. Adjunct intra-arterial thrombolysis was anticipated to play a major role in future MeVO treatment by 290/454 (63.9%). Conclusion Most physicians think that EVT is beneficial in selected MeVO patients. Enrolment bias was thought to be a major contributor to the neutral trial results. Ninety percent were equally or more willing to enroll patients in a second-generation MeVO-EVT trial. Adjunctive intra-arterial thrombolytics were identified as a key strategy for future MeVO-EVT.
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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 | 0.268 | 0.574 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.001 | 0.003 |
| Scholarly communication | 0.005 | 0.005 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 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".