Evidence map›Paper›PMID 24079677›Full record

SynthesisMayo Clinic proceedings2013

Endovascular therapy for acute ischemic stroke: a systematic review and meta-analysis.

Balwinder Singh, Ajay K Parsaik, Larry J Prokop, Manoj K Mittal

Abstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Mayo Clinic proceedings, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
20citing papers in PubMed, 7 pooled it
–field-weighted citation impact
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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

20 citing papers in PubMed, 7 syntheses or guidelines pooled it.

  1. Pooled it
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  8. Symptomatic intracranial hemorrhage in the ALIAS Multicenter Trial: relationship to endovascular thrombolytic therapy.International journal of stroke : official journal of the International Stroke Society · 2015
    Trial
  9. Article
  10. Article
  11. Article
  12. Organizing Healthcare for Optimal Acute Ischemic Stroke Treatment.Journal of clinical neurology (Seoul, Korea) · 2020
    Review
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  14. Review
  15. Article
  16. Review
  17. Article
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  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

4 authors.

Balwinder SinghDepartment of Neurology, Mayo Clinic, Rochester, MN. Electronic address: singh.balwinder@alumni.mayo.edu.
Ajay K Parsaik
Larry J Prokop
Manoj K Mittal

Funding

Mayo Clinic Center for Translational Science ActivitiesUL1TR000135 · NCATS · MAYO CLINIC ROCHESTER · PI KHOSLA, SUNDEEP · 2012 to 2015
$41.2M
NCATS NIH HHS UL1 TR000135
6 · The paper itself

Abstract

objectiveTo consolidate the evidence from randomized trials for the use of endovascular therapy (ET) in patients with acute ischemic stroke.

methodsWe searched major databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus) from their inception to February 12, 2013, for randomized trials evaluating the efficacy of ET compared with standard of care for acute ischemic stroke. Pooled absolute and relative risk estimates were synthesized by using a random-effects model. Heterogeneity was assessed by using Q statistic and I(2) statistic. Subset analysis was performed for patients with severe stroke (National Institutes of Health Stroke Scale score ≥20). The study was conducted from January 15, 2013 to April 30, 2013.

resultsOf the 1252 retrieved articles, 5 randomized trials enrolling 1197 patients with acute ischemic stroke were included. Seven hundred eleven patients received ET, and 486 received intravenous (IV) tissue plasminogen activator. There was no significant improvement in any of the outcomes in patients receiving ET compared with those receiving IV thrombolysis. On subgroup analysis, ET was found to have better outcomes in patients with severe stroke (National Institutes of Health Stroke Scale score ≥20), showing a dose-response gradient and improving excellent, good, and fair outcomes by an additional 4%, 7%, and 13%, respectively, compared with IV thrombolysis.

conclusionOverall, ET is not superior to IV thrombolysis for acute ischemic strokes (level B recommendation). However, ET showed promise and improved outcomes in patients with severe strokes, but the evidence is limited due to sample size. There is a need for further trials evaluating the role of ET in this high-risk group.

Indexed as

Endovascular ProceduresThrombolytic TherapyDatabases, BibliographicHumansOutcome Assessment, Health CareRandomized Controlled Trials as TopicSeverity of Illness IndexStrokeAANacute ischemic strokeAISAmerican Academy of Neurologyendovascular therapyETIMSInterventional Management of StrokeintravenousIVMechanical Retrieval and Recanalization of Stroke Clots Using Embolectomymodified Rankin ScaleMR-RESCUEmRSNational Institute of Health Stroke ScaleNIHSSrandomized controlled trialRCTrisk ratioRRsICHsymptomatic intracranial hemorrhagetissue plasminogen activatortPA

Identifiers

PMID24079677
PMCPMC3883722

What OpenQuestion holds

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Registered trials

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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.