Recanalization and initial poor collateral circulation determine the effect of collateral recruitment on functional outcomes. (P3.068)
Bibliographic record
Abstract
Background: Intracranial leptomeningeal collaterals are an important compensatory response for acute ischemic stroke (AIS). However, the relationship between their evolution and effects on regional blood flow are unclear. In a previous study we have found that delayed collateral recruitment was associated with worse functional outcomes. We stratified by various factors and compared collaterals on the pre-treatment and day-2 computed tomographic angiograms (CTA) of the brain to assess recruitment and the relationship with functional outcome in AIS patients treated with intravenous tissue plasminogen activator (IV-tPA). Methods: Consecutive AIS patients who underwent pre-treatment and day-2 CTA and received IV-tPA during 2010-2013 were included. Collaterals were evaluated by 2 independent neuroradiologists using 3 predefined criteria- Miteff’s system, Maas system and 20-point collateral scale by the Alberta Stroke Program Early CT score (ASPECTS) methodology. Good outcomes at 3-months were defined by a modified Rankin scale (mRS) scores of 0-1. Significant intracranial hemorrhage was defined as a bleed with a drop in NIHSS by 4 or more points. Results: This study included 209 patients. Delayed collateral recruitment on the follow-up CTA was significantly associated with increased mortality in 2 of the 3 grading systems. Collateral recruitment by ASPECTS system showed a trend for SICH. When stratified by the collateral grading on the initial CTA, all 3 scoring systems showed that poor collateral status on pre-treatment CTA with subsequent collateral recruitment was significantly associated with poor outcome and increased bleeding risk. When stratified by recanalization status of the primary occlusion, a lack of recanalization with collateral recruitment was associated with worse outcomes. No other factors significantly affected the functional outcomes. Conclusion: Delayed collateral recruitment results in higher mortality. Pre-thrombolysis collateral status and recanalization of the occluded artery are important determinants of how intracranial collateral evolution affects functional outcome in IV-tPA treated AIS patients.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 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".