Abstract 400: Antiplatelet therapy in Emergent Stenting during Mechanical Thrombectomy for Patients with Acute Ischemic Stroke and Underlying Intracranial Atherosclerosis: A sub‐analysis from the RESCUE‐ICAS registry
Bibliographic record
Abstract
Introduction/Purpose Large vessel occlusions with underlying ICAS (ICAS‐LVO) are challenging to treat and may require rescue stenting (RS). However, the ideal protocol of antiplatelet therapy (APT) after RS is unknown. We investigated the safety and efficacy of APT in patients that underwent RS due to ICAS‐LVO. Materials/Methods We conducted a sub‐analysis of the Registry of Emergent Large Vessel Occlusion due to Intracranial Stenosis (RESCUE‐ICAS), to investigate the efficacy and safety of APT in patients that required RS. The APT evaluated were glycoprotein IIb/IIIa inhibitors (GPI) and P2Y12 antagonists. GPI included eptifibatide and tirofiban, while P2Y12 inhibitors involved cangrelor. Primary efficacy outcomes were successful recanalization (detailed as a thrombolysis in cerebral ischemia [TICI] ≥ 2b at the end of the procedure). Secondary efficacy outcomes involved excellent recanalization (TICI ≥ 2c) and complete recanalization (TICI 3). Primary safety outcomes included symptomatic intracranial hemorrhage (sICH), and secondary safety outcomes involved vessel re‐occlusion, any ICH, in‐hospital mortality and recurrent stroke in 90 days. Results A total of 149 patients were included, 122/149 (81.9%) patients received GPI and 27/149 (18.1%) P2Y12 antagonists. Patients receiving GPI had higher number of passes compared to the ones in the P2Y12 cohort (median: 3 [IQR: 2‐4] vs median: 2 [IQR: 1‐4], p = 0.02). Likewise, patients that had GPI infusion tended to have better successful recanalization rates (TICI ≥ 2b, 94.3% vs 85.9%, p = 0.22), higher rates of excellent recanalization (TICI 2c, 48.4% vs 18.5%, p = 0.004) and complete recanalization (TICI 3, 27.9% vs 0.0%, p < 0.001) compared to their counterpart receiving P2Y12 antagonists. No difference was found in the rate of sICH (5.7% vs 3.7%, p = 1.00), re‐occlusion (12/68 [17.6%] vs 1/68 [1.47%], p = 1.00), intraprocedural complications rates (7.4% vs 11.1%, p = 0.46), any ICH (27.9% vs 18.5%, p = 0.47), in‐hospital mortality (18.2% vs 4.5%, p = 0.20) or recurrent stroke (9.0% vs 7.4%, p = 1.00) between both groups. Conclusions The use of APT in RS for ICAS‐LVO appears to be safe and effective. The administration of GPI might be superior to P2Y12 antagonists in achieving higher rates of successful recanalization.
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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 | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 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".