Evidence map›Paper›PMID 26138125›Full record

Trial reportStroke2015

Impact of General Anesthesia on Safety and Outcomes in the Endovascular Arm of Interventional Management of Stroke (IMS) III Trial.

Alex Abou-Chebl, Sharon D Yeatts, Bernard Yan, Kevin Cockroft, Mayank Goyal, Tudor Jovin, Pooja Khatri, Phillip Meyers, Judith Spilker, Rebecca Sugg and 4 more

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

Trial report in Stroke, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00359424 (Interventional Management of Stroke Trial), which is not on this map. Cited by 33 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
33citing papers in PubMed, 8 pooled it
8.9field-weighted citation impact, top 2% 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.

NCT00359424 phase3terminatednot on this map

Interventional Management of Stroke Trial (IMS III): A Phase III Clinical Trial Examining Whether a Combined Intravenous (IV) and Intra-Arterial (IA) Approach to Recanalization is Superior to Standard IV Rt-PA (Activase®) Alone

TypeinterventionalSponsorJoseph BroderickRan2006 to 2013Enrolled656ConditionsStrokeArmsIV rt-PA alone, endovascular therapy
3 · Its place in the literature

Who cites it

33 citing papers in PubMed, 8 syntheses or guidelines pooled it, 106 citations in OpenAlex.

  1. Type of anaesthesia for acute ischaemic stroke endovascular treatment.The Cochrane database of systematic reviews · 2022
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors at 1 institution in 1 country.

Alex Abou-CheblFrom Baptist Neuroscience Associates, Baptist Health, Louisville, KY (A.A.-C.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (S.D.Y.); Department of Neurology, Royal Melbourne Hospital, Parkville, Australia (B.Y.); Departments of Neurosurgery, Radiology, and Public Health Sciences, Penn State Hershey, PA (K.C.); Departments of Radiology and Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada (M.G.); Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.); Department of Neurology (P.K., J.S., J.B.) and Department of Radiology (T.T.), University of Cincinnati, OH; Departments of Radiology and Neurological Surgery, Columbia University, New York, NY (P.M.); Department of Neurology, University of Mississippi, Jackson (R.S.); Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (K.E.W.); and Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (M.D.H.). achebl@yahoo.com.
Sharon D YeattsFrom Baptist Neuroscience Associates, Baptist Health, Louisville, KY (A.A.-C.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (S.D.Y.); Department of Neurology, Royal Melbourne Hospital, Parkville, Australia (B.Y.); Departments of Neurosurgery, Radiology, and Public Health Sciences, Penn State Hershey, PA (K.C.); Departments of Radiology and Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada (M.G.); Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.); Department of Neurology (P.K., J.S., J.B.) and Department of Radiology (T.T.), University of Cincinnati, OH; Departments of Radiology and Neurological Surgery, Columbia University, New York, NY (P.M.); Department of Neurology, University of Mississippi, Jackson (R.S.); Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (K.E.W.); and Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (M.D.H.).
Bernard YanFrom Baptist Neuroscience Associates, Baptist Health, Louisville, KY (A.A.-C.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (S.D.Y.); Department of Neurology, Royal Melbourne Hospital, Parkville, Australia (B.Y.); Departments of Neurosurgery, Radiology, and Public Health Sciences, Penn State Hershey, PA (K.C.); Departments of Radiology and Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada (M.G.); Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.); Department of Neurology (P.K., J.S., J.B.) and Department of Radiology (T.T.), University of Cincinnati, OH; Departments of Radiology and Neurological Surgery, Columbia University, New York, NY (P.M.); Department of Neurology, University of Mississippi, Jackson (R.S.); Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (K.E.W.); and Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (M.D.H.).
Kevin CockroftFrom Baptist Neuroscience Associates, Baptist Health, Louisville, KY (A.A.-C.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (S.D.Y.); Department of Neurology, Royal Melbourne Hospital, Parkville, Australia (B.Y.); Departments of Neurosurgery, Radiology, and Public Health Sciences, Penn State Hershey, PA (K.C.); Departments of Radiology and Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada (M.G.); Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.); Department of Neurology (P.K., J.S., J.B.) and Department of Radiology (T.T.), University of Cincinnati, OH; Departments of Radiology and Neurological Surgery, Columbia University, New York, NY (P.M.); Department of Neurology, University of Mississippi, Jackson (R.S.); Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (K.E.W.); and Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (M.D.H.).
Mayank GoyalFrom Baptist Neuroscience Associates, Baptist Health, Louisville, KY (A.A.-C.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (S.D.Y.); Department of Neurology, Royal Melbourne Hospital, Parkville, Australia (B.Y.); Departments of Neurosurgery, Radiology, and Public Health Sciences, Penn State Hershey, PA (K.C.); Departments of Radiology and Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada (M.G.); Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.); Department of Neurology (P.K., J.S., J.B.) and Department of Radiology (T.T.), University of Cincinnati, OH; Departments of Radiology and Neurological Surgery, Columbia University, New York, NY (P.M.); Department of Neurology, University of Mississippi, Jackson (R.S.); Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (K.E.W.); and Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (M.D.H.).
Tudor JovinFrom Baptist Neuroscience Associates, Baptist Health, Louisville, KY (A.A.-C.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (S.D.Y.); Department of Neurology, Royal Melbourne Hospital, Parkville, Australia (B.Y.); Departments of Neurosurgery, Radiology, and Public Health Sciences, Penn State Hershey, PA (K.C.); Departments of Radiology and Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada (M.G.); Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.); Department of Neurology (P.K., J.S., J.B.) and Department of Radiology (T.T.), University of Cincinnati, OH; Departments of Radiology and Neurological Surgery, Columbia University, New York, NY (P.M.); Department of Neurology, University of Mississippi, Jackson (R.S.); Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (K.E.W.); and Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (M.D.H.).
Pooja KhatriFrom Baptist Neuroscience Associates, Baptist Health, Louisville, KY (A.A.-C.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (S.D.Y.); Department of Neurology, Royal Melbourne Hospital, Parkville, Australia (B.Y.); Departments of Neurosurgery, Radiology, and Public Health Sciences, Penn State Hershey, PA (K.C.); Departments of Radiology and Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada (M.G.); Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.); Department of Neurology (P.K., J.S., J.B.) and Department of Radiology (T.T.), University of Cincinnati, OH; Departments of Radiology and Neurological Surgery, Columbia University, New York, NY (P.M.); Department of Neurology, University of Mississippi, Jackson (R.S.); Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (K.E.W.); and Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (M.D.H.).
Phillip MeyersFrom Baptist Neuroscience Associates, Baptist Health, Louisville, KY (A.A.-C.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (S.D.Y.); Department of Neurology, Royal Melbourne Hospital, Parkville, Australia (B.Y.); Departments of Neurosurgery, Radiology, and Public Health Sciences, Penn State Hershey, PA (K.C.); Departments of Radiology and Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada (M.G.); Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.); Department of Neurology (P.K., J.S., J.B.) and Department of Radiology (T.T.), University of Cincinnati, OH; Departments of Radiology and Neurological Surgery, Columbia University, New York, NY (P.M.); Department of Neurology, University of Mississippi, Jackson (R.S.); Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (K.E.W.); and Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (M.D.H.).
Judith SpilkerFrom Baptist Neuroscience Associates, Baptist Health, Louisville, KY (A.A.-C.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (S.D.Y.); Department of Neurology, Royal Melbourne Hospital, Parkville, Australia (B.Y.); Departments of Neurosurgery, Radiology, and Public Health Sciences, Penn State Hershey, PA (K.C.); Departments of Radiology and Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada (M.G.); Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.); Department of Neurology (P.K., J.S., J.B.) and Department of Radiology (T.T.), University of Cincinnati, OH; Departments of Radiology and Neurological Surgery, Columbia University, New York, NY (P.M.); Department of Neurology, University of Mississippi, Jackson (R.S.); Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (K.E.W.); and Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (M.D.H.).
Rebecca SuggFrom Baptist Neuroscience Associates, Baptist Health, Louisville, KY (A.A.-C.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (S.D.Y.); Department of Neurology, Royal Melbourne Hospital, Parkville, Australia (B.Y.); Departments of Neurosurgery, Radiology, and Public Health Sciences, Penn State Hershey, PA (K.C.); Departments of Radiology and Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada (M.G.); Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.); Department of Neurology (P.K., J.S., J.B.) and Department of Radiology (T.T.), University of Cincinnati, OH; Departments of Radiology and Neurological Surgery, Columbia University, New York, NY (P.M.); Department of Neurology, University of Mississippi, Jackson (R.S.); Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (K.E.W.); and Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (M.D.H.).
Katja E WartenbergFrom Baptist Neuroscience Associates, Baptist Health, Louisville, KY (A.A.-C.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (S.D.Y.); Department of Neurology, Royal Melbourne Hospital, Parkville, Australia (B.Y.); Departments of Neurosurgery, Radiology, and Public Health Sciences, Penn State Hershey, PA (K.C.); Departments of Radiology and Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada (M.G.); Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.); Department of Neurology (P.K., J.S., J.B.) and Department of Radiology (T.T.), University of Cincinnati, OH; Departments of Radiology and Neurological Surgery, Columbia University, New York, NY (P.M.); Department of Neurology, University of Mississippi, Jackson (R.S.); Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (K.E.W.); and Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (M.D.H.).
Tom TomsickFrom Baptist Neuroscience Associates, Baptist Health, Louisville, KY (A.A.-C.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (S.D.Y.); Department of Neurology, Royal Melbourne Hospital, Parkville, Australia (B.Y.); Departments of Neurosurgery, Radiology, and Public Health Sciences, Penn State Hershey, PA (K.C.); Departments of Radiology and Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada (M.G.); Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.); Department of Neurology (P.K., J.S., J.B.) and Department of Radiology (T.T.), University of Cincinnati, OH; Departments of Radiology and Neurological Surgery, Columbia University, New York, NY (P.M.); Department of Neurology, University of Mississippi, Jackson (R.S.); Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (K.E.W.); and Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (M.D.H.).
Joe BroderickFrom Baptist Neuroscience Associates, Baptist Health, Louisville, KY (A.A.-C.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (S.D.Y.); Department of Neurology, Royal Melbourne Hospital, Parkville, Australia (B.Y.); Departments of Neurosurgery, Radiology, and Public Health Sciences, Penn State Hershey, PA (K.C.); Departments of Radiology and Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada (M.G.); Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.); Department of Neurology (P.K., J.S., J.B.) and Department of Radiology (T.T.), University of Cincinnati, OH; Departments of Radiology and Neurological Surgery, Columbia University, New York, NY (P.M.); Department of Neurology, University of Mississippi, Jackson (R.S.); Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (K.E.W.); and Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (M.D.H.).
Michael D HillFrom Baptist Neuroscience Associates, Baptist Health, Louisville, KY (A.A.-C.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (S.D.Y.); Department of Neurology, Royal Melbourne Hospital, Parkville, Australia (B.Y.); Departments of Neurosurgery, Radiology, and Public Health Sciences, Penn State Hershey, PA (K.C.); Departments of Radiology and Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada (M.G.); Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.); Department of Neurology (P.K., J.S., J.B.) and Department of Radiology (T.T.), University of Cincinnati, OH; Departments of Radiology and Neurological Surgery, Columbia University, New York, NY (P.M.); Department of Neurology, University of Mississippi, Jackson (R.S.); Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (K.E.W.); and Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (M.D.H.).
Melbourne Health · AU

Funding

Interventional Management of Stroke Study (IMS III)U01NS052220 · NINDS · UNIVERSITY OF CINCINNATI · PI BRODERICK, JOSEPH PAUL · 2005 to 2012
$21.9M
Interventional Management of Stroke Phase III Trial - SDCCU01NS077304 · NINDS · MEDICAL UNIVERSITY OF SOUTH CAROLINA · PI PALESCH, YUKO Y · 2011 to 2013
$1.4M
NINDS NIH HHS U01 NS052220NINDS NIH HHS U01 NS077304
6 · The paper itself

Abstract

background and purposeGeneral anesthesia (GA) for endovascular therapy (EVT) of acute ischemic stroke may be associated with worse outcomes.

methodsThe Interventional Management of Stroke III trial randomized patients within 3 hours of acute ischemic stroke onset to intravenous tissue-type plasminogen activator±EVT. GA use within 7 hours of stroke onset was recorded per protocol. Good outcome was defined as 90-day modified Rankin Scale ≤2. A multivariable analysis adjusting for dichotomized National Institutes of Health Stroke Scale (NIHSS; 8-19 versus ≥20), age, and time from onset to groin puncture was performed.

resultsFour hundred thirty-four patients were randomized to EVT, 269 (62%) were treated under local anesthesia and 147 (33.9%) under GA; 18 (4%) were undetermined. The 2 groups were comparable except for median baseline NIHSS (16 local anesthesia versus 18 GA; P<0.0001). The GA group was less likely to achieve a good outcome (adjusted relative risk, 0.68; confidence interval, 0.52-0.90; P=0.0056) and had increased in-hospital mortality (adjusted relative risk, 2.84; confidence interval, 1.65-4.91; P=0.0002). Those with medically indicated GA had worse outcomes (adjusted relative risk, 0.49; confidence interval, 0.30-0.81; P=0.005) and increased mortality (relative risk, 3.93; confidence interval, 2.18-7.10; P<0.0001) with a trend for higher mortality with routine GA. There was no significant difference in the adjusted risks of subarachnoid hemorrhage (P=0.32) or symptomatic intracerebral hemorrhage (P=0.37).

conclusionsGA was associated with worse neurological outcomes and increased mortality in the EVT arm; this was primarily true among patients with medical indications for GA. Relative risk estimates, though not statistically significant, suggest reduced risk for subarachnoid hemorrhage and symptomatic intracerebral hemorrhage under local anesthesia. Although the reasons for these associations are not clear, these data support the use of local anesthesia when possible during EVT. CLINICAL

trial registrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT00359424.

Indexed as

Disease ManagementEarly Medical InterventionAdultAgedAged, 80 and overAnesthesia, GeneralCohort StudiesEndovascular ProceduresFemaleHumansMaleMiddle AgedPatient SafetyStrokeTreatment OutcomeYoung Adultanesthesiaembolectomyendovascular proceduresinjections, intra-arterialstrokethrombolysis

Identifiers

PMID26138125
PMCPMC4519363
OpenAlexW1953282499

What OpenQuestion holds

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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.