Evidence map›Paper›PMID 24784550›Full record

Trial reportThe Lancet. Neurology2014

Time to angiographic reperfusion and clinical outcome after acute ischaemic stroke: an analysis of data from the Interventional Management of Stroke (IMS III) phase 3 trial.

Pooja Khatri, Sharon D Yeatts, Mikael Mazighi, Joseph P Broderick, David S Liebeskind, Andrew M Demchuk, Pierre Amarenco, Janice Carrozzella, Judith Spilker, Lydia D Foster and 8 more

Registry-linked trialAbstract readClinical Trial, Phase IIIMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The Lancet. Neurology, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04142879 (Automated Detection and Triage of Large Vessel Occlusions Using Artificial Intelligence for Early and Rapid Treatment), which is not on this map. Cited by 152 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
152citing papers in PubMed, 6 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.

NCT04142879 unknown statusnot on this mapstarted 2019, after this paper: background citation

Automated Detection and Triage of Large Vessel Occlusions Using Artificial Intelligence for Early and Rapid Treatment (ALERT)

TypeobservationalSponsorProvidence Little Company of Mary-TorranceRan2019 to 2021Enrolled500ConditionsStroke Workflow and Clinical Outcome ParametersArmsViz Device Software
3 · Its place in the literature

Who cites it

152 citing papers in PubMed, 6 syntheses or guidelines pooled it.

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92 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

18 authors.

Pooja KhatriUniversity of Cincinnati, Cincinnati, OH, USA. Electronic address: pooja.khatri@uc.edu.
Sharon D YeattsMedical University of South Carolina, Charleston, SC, USA.
Mikael MazighiParis-Diderot University, Bichat University Hospital, Paris, France.
Joseph P BroderickUniversity of Cincinnati, Cincinnati, OH, USA.
David S LiebeskindUniversity of California, Los Angeles, Los Angeles, CA, USA.
Andrew M DemchukUniversity of Calgary, Calgary, AB, Canada.
Pierre AmarencoParis-Diderot University, Bichat University Hospital, Paris, France.
Janice CarrozzellaUniversity of Cincinnati, Cincinnati, OH, USA.
Judith SpilkerUniversity of Cincinnati, Cincinnati, OH, USA.
Lydia D FosterMedical University of South Carolina, Charleston, SC, USA.
Mayank GoyalUniversity of Calgary, Calgary, AB, Canada.
Michael D HillUniversity of Calgary, Calgary, AB, Canada.
Yuko Y PaleschMedical University of South Carolina, Charleston, SC, USA.
Edward C JauchMedical University of South Carolina, Charleston, SC, USA.
E Clarke HaleyUniversity of Virginia Health System, Charlottesville, VA, USA.
Achala VagalUniversity of Cincinnati, Cincinnati, OH, USA.
Thomas A TomsickUniversity of Cincinnati, Cincinnati, OH, USA.
IMS III Trialists

Funding

Interventional Management of Stroke Study (IMS III)U01NS052220 · NINDS · UNIVERSITY OF CINCINNATI · PI BRODERICK, JOSEPH PAUL · 2005 to 2012
$21.9M
The ALIAS StudyU01NS054630 · NINDS · MEDICAL UNIVERSITY OF SOUTH CAROLINA · PI PALESCH, YUKO Y · 2005 to 2010
$6.9M
Interventional Management of Stroke Phase III Trial - SDCCU01NS077304 · NINDS · MEDICAL UNIVERSITY OF SOUTH CAROLINA · PI PALESCH, YUKO Y · 2011 to 2013
$1.4M
Modeling of Collateral Perfusion in the Ischemic BrainK24NS072272 · NINDS · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI LIEBESKIND, DAVID SIGMUND · 2011 to 2015
$939k
The Significance of Intracranial Hemorrhage after Revascularization TherapyK23NS059843 · NINDS · UNIVERSITY OF CINCINNATI · PI KHATRI, POOJA · 2007 to 2011
$778k
NINDS NIH HHS K23 NS059843NINDS NIH HHS K24 NS072272NINDS NIH HHS U01 NS052220NINDS NIH HHS U01 NS054630NINDS NIH HHS U01 NS077304
6 · The paper itself

Abstract

backgroundThe IMS III trial did not show a clinical benefit of endovascular treatment compared with intravenous alteplase (recombinant tissue plasminogen activator) alone for moderate or severe ischaemic strokes. Late reperfusion of tissue that was no longer salvageable could be one explanation, as suggested by previous exploratory studies that showed an association between time to reperfusion and good clinical outcome. We sought to validate this association in a preplanned analysis of data from the IMS III trial.

methodsWe used data for patients with complete proximal arterial occlusions in the anterior circulation who received endovascular treatment and achieved angiographic reperfusion (score on Thrombolysis in Cerebral Infarction scale of grade 2-3) during the endovascular procedure (within 7 h of symptom onset). We used logistic regression to model good clinical outcome (defined as a modified Rankin Scale score of 0-2 at 3 months) as a function of the time to reperfusion. We prespecified variables to be considered for adjustment, including age, baseline National Institutes of Health Stroke Scale score, sex, and baseline blood glucose concentration.

findingsOf 240 patients who were otherwise eligible for inclusion in our analysis, 182 (76%) achieved angiographic reperfusion. Mean time from symptom onset to reperfusion (ie, procedure end) was 325 min (SD 52). Increased time to reperfusion was associated with a decreased likelihood of good clinical outcome (unadjusted relative risk for every 30-min delay 0·85 [95% CI 0·77-0·94]; adjusted relative risk 0·88 [0·80-0·98]).

interpretationDelays in time to angiographic reperfusion lead to a decreased likelihood of good clinical outcome in patients after moderate to severe stroke. Rapid reperfusion could be crucial for the success of future acute endovascular trials.

fundingUS National Institutes of Health and National Institute of Neurological Disorders and Stroke.

Indexed as

Brain IschemiaStrokeAdolescentAdultAgedCarotid Artery DiseasesCerebral AngiographyEndovascular ProceduresFemaleFibrinolytic AgentsHumansInfarction, Middle Cerebral ArteryMaleMiddle AgedReperfusionTime FactorsFibrinolytic AgentsTissue Plasminogen Activator

Identifiers

PMID24784550
PMCPMC4174410

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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.