Evidence map›Paper›PMID 25365799›Full record

ReviewBrain and behavior2014

Comparative efficacy of different acute reperfusion therapies for acute ischemic stroke: a comprehensive benefit-risk analysis of clinical trials.

Georgios Tsivgoulis, John Alleman, Aristeidis H Katsanos, Andrew D Barreto, Martin Kohrmann, Peter D Schellinger, Carlos A Molina, Andrei V Alexandrov

Open access · goldAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Brain and behavior, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
1.7field-weighted citation impact, top 16% 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.

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

5 citing papers in PubMed, 13 citations in OpenAlex.

  1. Article
  2. Article
  3. Endovascular thrombectomy with or without systemic thrombolysis?Therapeutic advances in neurological disorders · 2017
    Article
  4. Observational
  5. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 7 institutions in 6 countries.

Georgios TsivgoulisDepartment of Neurology, University of Tennessee Health Science Center Memphis, Tennessee ; Second Department of Neurology, "Attikon Hospital", School of Medicine, University of Athens Athens, Greece ; International Clinical Research Center, St. Anne's University Hospital in Brno Brno, Czech Republic.
John AllemanCerevast Therapeutics, Inc. Redmond, Washington.
Aristeidis H KatsanosDepartment of Neurology, University of Ioannina Ioannina, Greece.
Andrew D BarretoDepartment of Neurology, University of Texas-Houston Medical School Houston, Texas.
Martin KohrmannDepartment of Neurology, University Clinic at Erlangen Erlangen, Germany.
Peter D SchellingerDepartments of Neurology and Neurogeriatry, Johannes Wesling Clinic Minden Minden, Germany.
Carlos A MolinaNeurovascular Unit, Department of Neurology, Hospital Vall d'Hebron Barcelona, Spain.
Andrei V AlexandrovDepartment of Neurology, University of Tennessee Health Science Center Memphis, Tennessee.
University of Tennessee Health Science Center · USJohannes Wesling Klinikum Minden · DEMidwest Orthopaedic Research Foundation · USThe University of Texas Health Science Center at Houston · USUniversitätsklinikum Erlangen · DEUniversity of Ioannina · GRVall d'Hebron Hospital Universitari · ES

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundNumerous acute reperfusion therapies (RPT) are currently investigated as potential new therapeutic targets in acute ischemic stroke (AIS). We conducted a comprehensive benefit-risk analysis of available clinical studies assessing different acute RPT, and investigated the utility of each intervention in comparison to standard intravenous thrombolysis (IVT) and in relation to the onset-to-treatment time (OTT).

methodsA comprehensive literature search was conducted to identify all available published, peer-reviewed clinical studies that evaluated the efficacy of different RPT in AIS. Benefit-to-risk ratio (BRR), adjusted for baseline stroke severity, was estimated as the percentage of patients achieving favorable functional outcome (BRR1, mRS score: 0-1) or functional independence (BRR2, mRS score: 0-2) at 3 months divided by the percentage of patients who died during the same period.

resultsA total of 18 randomized (n = 13) and nonrandomized (n = 5) clinical studies fulfilled our inclusion criteria. IV therapy with tenecteplase (TNK) was found to have the highest BRRs (BRR1 = 5.76 and BRR2 = 6.82 for low-dose TNK; BRR1 = 5.80 and BRR2 = 6.87 for high-dose TNK), followed by sonothrombolysis (BRR1 = 2.75 and BRR2 = 3.38), while endovascular thrombectomy with MERCI retriever was found to have the lowest BRRs (BRR1 range, 0.31-0.65; BRR2 range, 0.52-1.18). A second degree negative polynomial correlation was detected between favorable functional outcome and OTT (R (2) value: 0.6419; P < 0.00001) indicating the time dependency of clinical efficacy of all reperfusion therapies.

conclusionIntravenous thrombolysis (IVT) with TNK and sonothrombolysis have the higher BRR among investigational reperfusion therapies. The combination of sonothrombolysis with IV administration of TNK appears a potentially promising therapeutic option deserving further investigation.

Indexed as

Brain IschemiaClinical Trials as TopicFibrinolytic AgentsHumansReperfusionRisk AssessmentStrokeTenecteplaseTissue Plasminogen ActivatorUltrasonic TherapyFibrinolytic AgentsTenecteplaseTissue Plasminogen ActivatorAcute strokeanalysisbenefit-to-risk ratioreperfusion therapies

Identifiers

PMID25365799
PMCPMC4178251
OpenAlexW2079195864

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.