Evidence map›Paper›PMID 23387822›Full record

Trial reportThe New England journal of medicine2013

Endovascular treatment for acute ischemic stroke.

Alfonso Ciccone, Luca Valvassori, Michele Nichelatti, Annalisa Sgoifo, Michela Ponzio, Roberto Sterzi, Edoardo Boccardi, SYNTHESIS Expansion Investigators

4 registry-linked trialsOpen access · bronzeAbstract readComparative StudyMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The New England journal of medicine, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 4 registered trials, which are not on this map. Cited by 400 papers, 21 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
400citing papers in PubMed, 21 pooled it
158.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00640367 phase3completednot on this map

Synthesis Expansion: A Randomized Controlled Trial on Intra-Arterial Versus Intravenous Thrombolysis in Acute Ischemic Stroke

TypeinterventionalSponsorNiguarda HospitalRan2008 to 2012Enrolled350ConditionsStroke, Cerebrovascular AccidentArmsAlteplase IA and/or mechanical thrombolysis, Alteplase IV
NCT02441556 nacompletednot on this mapstarted 2015, after this paper: background citation

Acute Basilar Artery Occlusion: Endovascular Interventions vs Standard Medical Treatment

TypeinterventionalSponsorXinfeng LiuRan2015 to 2017Enrolled131ConditionsStroke Due to Basilar Artery Occlusion, Acute Cerebrovascular AccidentsArmsendovascular treatment, standard medical therapy
NCT03519737 naunknown statusnot on this mapstarted 2018, after this paper: background citation

A Phase 3, Randomized, Placebo-Controlled, Double-Blind Study of the Aureva Transcranial Ultrasound Device With Tissue Plasminogen Activator in Patients With Acute Ischemic Stroke (TRUST)

TypeinterventionalSponsorCerevast Medical, Inc.Ran2018 to 2021Enrolled596ConditionsAcute Ischemic StrokeArmstPA in combination with the Sonolysis Headframe (TUS), tPA in combination with the Sonolysis Headframe (Sham TUS)
NCT05675774 nacompletednot on this mapstarted 2023, after this paper: background citation

Dual Energy CT for Confirming Hemorrhagic Transformation After Thrombectomy for Patients With Acute Ischemic Stroke

TypeinterventionalSponsorUniversity of ManitobaRan2023 to 2025Enrolled189ConditionsStroke, Ischemic, Tomography, X-Ray ComputedArmsDual Energy CT
3 · Its place in the literature

Who cites it

400 citing papers in PubMed, 21 syntheses or guidelines pooled it, 1,276 citations in OpenAlex.

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  3. Mechanical thrombectomy with retrievable stents and aspiration catheters for acute ischaemic stroke: a meta-analysis of randomised controlled trials.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2022
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  14. Mechanical Thrombectomy in Acute Ischemic Stroke: A Systematic Review.The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques · 2016
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340 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 4 institutions in 2 countries.

Alfonso CicconeStroke Unit and Department of Neurology, Niguarda Ca' Granda Hospital, Milan, Italy. alfonso.ciccone@aopoma.it
Luca Valvassori
Michele Nichelatti
Annalisa Sgoifo
Michela Ponzio
Roberto Sterzi
Edoardo Boccardi
SYNTHESIS Expansion Investigators
Stroke Association · GBAzienda Ospedaliera Carlo Poma · ITAzienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda · ITUniversity of Pavia · IT

Funding

Neurovascular Adhesion Receptors and Barrier IntegrityR01NS053716 · NINDS · UNIVERSITY OF WASHINGTON · PI DEL ZOPPO, GREGORY J · 2006 to 2016
$3.5M
Matrix Metalloproteinases and Neurons in Focal IschemiaR37NS038710 · NINDS · UNIVERSITY OF WASHINGTON · PI DEL ZOPPO, GREGORY J · 2004 to 2010
$3.2M
NINDS NIH HHS R01 NS053716NINDS NIH HHS R37 NS038710
6 · The paper itself

Abstract

backgroundIn patients with ischemic stroke, endovascular treatment results in a higher rate of recanalization of the affected cerebral artery than systemic intravenous thrombolytic therapy. However, comparison of the clinical efficacy of the two approaches is needed.

methodsWe randomly assigned 362 patients with acute ischemic stroke, within 4.5 hours after onset, to endovascular therapy (intraarterial thrombolysis with recombinant tissue plasminogen activator [t-PA], mechanical clot disruption or retrieval, or a combination of these approaches) or intravenous t-PA. Treatments were to be given as soon as possible after randomization. The primary outcome was survival free of disability (defined as a modified Rankin score of 0 or 1 on a scale of 0 to 6, with 0 indicating no symptoms, 1 no clinically significant disability despite symptoms, and 6 death) at 3 months.

resultsA total of 181 patients were assigned to receive endovascular therapy, and 181 intravenous t-PA. The median time from stroke onset to the start of treatment was 3.75 hours for endovascular therapy and 2.75 hours for intravenous t-PA (P<0.001). At 3 months, 55 patients in the endovascular-therapy group (30.4%) and 63 in the intravenous t-PA group (34.8%) were alive without disability (odds ratio adjusted for age, sex, stroke severity, and atrial fibrillation status at baseline, 0.71; 95% confidence interval, 0.44 to 1.14; P=0.16). Fatal or nonfatal symptomatic intracranial hemorrhage within 7 days occurred in 6% of the patients in each group, and there were no significant differences between groups in the rates of other serious adverse events or the case fatality rate.

conclusionsThe results of this trial in patients with acute ischemic stroke indicate that endovascular therapy is not superior to standard treatment with intravenous t-PA. (Funded by the Italian Medicines Agency, ClinicalTrials.gov number, NCT00640367.).

Indexed as

ThrombectomyAcute DiseaseAdultAgedBrain IschemiaCerebral AngiographyCerebral HemorrhageCombined Modality TherapyEndovascular ProceduresFemaleFibrinolytic AgentsHumansInfusions, IntravenousMaleMiddle AgedSingle-Blind MethodFibrinolytic AgentsTissue Plasminogen Activator

Identifiers

PMID23387822
PMCPMC3708480
OpenAlexW2114603310

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.