Thrombectomy in SUS: a new perspective to the AIS treatments
Bibliographic record
Abstract
Background: Recently, the Brazilian Ministry of Health instituted Ordinance: GM/MS No. 1996 of 11/24/2023, regarding the implementation of Mechanical Thrombectomy (MT) in the SUS, guaranteeing this treatment option in applicable cases of Acute Ischemic Stroke (AIS) with a symptomatic signals between 8 and 24 hours. MT consists of removing the obstructive content that impedes blood flow to the brain, resulting in acute ischemia and neurological deficit. According to DATASUS, between 2022-2023, AIS caused 55 thousand deaths. Therefore, with this possibility, there are expectations of reducing the number of deaths and alleviating serious functional disabilities. Objective: To evaluate the effectiveness of treating AIS with mechanical thrombectomy and outline prospective parameters for Brazil with the implementation of GM/MS regulation nº1996 of 11/24/2023. Methods: Records were collected on the PubMed platform with the descriptors: Thrombectomy, Acute Ischemic Stroke. Randomized clinical trial studies were selected that highlight the advantages and disadvantages of thrombectomy. Results: Studies have shown a positive prognosis with MT. Sarraj (2023), in a randomized and controlled clinical trial on AIS covering the United States, Canada, Europe, Australia and New Zealand, compared 178 patients who underwent MT in 24 hours with 174 who received only medical care with local protocols, the median ischemic volumes 74ml vs 77ml, both with a median of 4 on the ASPECTS (Alberta Stroke Early Score) and a median of 19 on the NIHSS (National Institutes of Health Stroke Scale) score. In the MT group, 142 (79.8%) had successful reperfusion, with 20.3% showing functional independence at 90 days (Modified Rankin Scale [mRS] from 0 to 2) and 37.9% with independent ambulation at 90 days (mRS from 0 to 3). Furthermore, 11.5% showed early neurological improvement (decreasing 8 points in the NIHSS), however 24.7% showed worsening of the neurological condition related to a larger ischemic area when compared to the group without neurological worsening. The hospital death rate was 23.6%. In the medical care group at 90 days, the median MRS was 5; functional independence at 90 days 7% (mRS 0-2); independent ambulation at 90 days 18.7% (mRS 0-3); deaths at 90 days 41.5% and neurological worsening 15.5%. Comparatively, MT obtained better results compared to the group that received only clinical care. Conclusion: The regulation of GM/MS No. 1996/24/11/2023 to accomplish thrombectomy in the SUS indicate a promising future, given the high effectiveness of the procedure and a better prognosis in reperfusion and the patient’s clinical condition 90 days after management, especially the decrease in the death rate. Therefore, the 12 institutions accredited for the procedure in Brazil can minimize national morbidity and mortality, with the need for further Brazilian comparative studies to assess the status before and after its implementation.
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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 | 0.005 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.005 | 0.003 |
| Science and technology studies | 0.001 | 0.003 |
| Scholarly communication | 0.003 | 0.007 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.004 |
| Insufficient payload (model declined to judge) | 0.003 | 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".