Evidence map›Paper›PMID 23394476›Full record

Trial reportThe New England journal of medicine2013

A trial of imaging selection and endovascular treatment for ischemic stroke.

Chelsea S Kidwell, Reza Jahan, Jeffrey Gornbein, Jeffry R Alger, Val Nenov, Zahra Ajani, Lei Feng, Brett C Meyer, Scott Olson, Lee H Schwamm and 9 more

3 registry-linked trialsOpen access · bronzeAbstract readClinical Trial, Phase IIMulticenter 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 3 registered trials, which are not on this map. Cited by 470 papers, 24 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
470citing papers in PubMed, 24 pooled it
164.9field-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.

NCT00389467 phase2completednot on this map

Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy

TypeinterventionalSponsorUniversity of California, Los AngelesRan2004 to 2012Enrolled127ConditionsStrokeArmsMerci Retriever and Penumbra System
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)
3 · Its place in the literature

Who cites it

470 citing papers in PubMed, 24 syntheses or guidelines pooled it, 1,373 citations in OpenAlex.

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  2. 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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  5. Guideline
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  17. Recanalisation therapies for wake-up stroke.The Cochrane database of systematic reviews · 2018
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410 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

19 authors at 8 institutions in 1 country.

Chelsea S KidwellDepartment of Neurology and the Stroke Center, Georgetown University, Washington, DC 20007, USA. ck256@georgetown.edu
Reza Jahan
Jeffrey Gornbein
Jeffry R Alger
Val Nenov
Zahra Ajani
Lei Feng
Brett C Meyer
Scott Olson
Lee H Schwamm
Albert J Yoo
Randolph S Marshall
Philip M Meyers
Dileep R Yavagal
Max Wintermark
Judy Guzy
Sidney Starkman
Jeffrey L Saver
MR RESCUE Investigators
University of California, Los Angeles · USColumbia University · USHarvard University Press · USKaiser Permanente · USUniversity of California, San Diego · USGeorgetown University · USUniversity of Miami · USUniversity of Virginia · US

Funding

UCLA SPOTRIAS CENTER APPLICATION RENEWAL-PROGRAM PROJECTP50NS044378 · NINDS · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI SAVER, JEFFREY L · 2003 to 2012
$17.2M
Miami Clinical and Translational Science InstituteUL1TR000460 · NCATS · UNIVERSITY OF MIAMI SCHOOL OF MEDICINE · PI SACCO, RALPH L. · 2012 to 2016
$16.9M
Modeling of Collateral Perfusion in the Ischemic BrainK24NS072272 · NINDS · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI LIEBESKIND, DAVID SIGMUND · 2011 to 2015
$939k
NCATS NIH HHS UL1 TR000460NINDS NIH HHS K24 NS072272NINDS NIH HHS P50 NS044378
6 · The paper itself

Abstract

backgroundWhether brain imaging can identify patients who are most likely to benefit from therapies for acute ischemic stroke and whether endovascular thrombectomy improves clinical outcomes in such patients remains unclear.

methodsIn this study, we randomly assigned patients within 8 hours after the onset of large-vessel, anterior-circulation strokes to undergo mechanical embolectomy (Merci Retriever or Penumbra System) or receive standard care. All patients underwent pretreatment computed tomography or magnetic resonance imaging of the brain. Randomization was stratified according to whether the patient had a favorable penumbral pattern (substantial salvageable tissue and small infarct core) or a nonpenumbral pattern (large core or small or absent penumbra). We assessed outcomes using the 90-day modified Rankin scale, ranging from 0 (no symptoms) to 6 (dead).

resultsAmong 118 eligible patients, the mean age was 65.5 years, the mean time to enrollment was 5.5 hours, and 58% had a favorable penumbral pattern. Revascularization in the embolectomy group was achieved in 67% of the patients. Ninety-day mortality was 21%, and the rate of symptomatic intracranial hemorrhage was 4%; neither rate differed across groups. Among all patients, mean scores on the modified Rankin scale did not differ between embolectomy and standard care (3.9 vs. 3.9, P=0.99). Embolectomy was not superior to standard care in patients with either a favorable penumbral pattern (mean score, 3.9 vs. 3.4; P=0.23) or a nonpenumbral pattern (mean score, 4.0 vs. 4.4; P=0.32). In the primary analysis of scores on the 90-day modified Rankin scale, there was no interaction between the pretreatment imaging pattern and treatment assignment (P=0.14).

conclusionsA favorable penumbral pattern on neuroimaging did not identify patients who would differentially benefit from endovascular therapy for acute ischemic stroke, nor was embolectomy shown to be superior to standard care. (Funded by the National Institute of Neurological Disorders and Stroke; MR RESCUE ClinicalTrials.gov number, NCT00389467.).

Indexed as

NeuroimagingThrombectomyAcute DiseaseAdultAgedAged, 80 and overAnalysis of VarianceBrainCerebral AngiographyDisability EvaluationFemaleFibrinolytic AgentsHumansMagnetic Resonance AngiographyMaleMiddle AgedFibrinolytic AgentsTissue Plasminogen Activator

Identifiers

PMID23394476
PMCPMC3690785
OpenAlexW2014796100

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.