Evidence map›Paper›PMID 26224727›Full record

ArticleNeurology2015

Response to endovascular reperfusion is not time-dependent in patients with salvageable tissue.

Maarten G Lansberg, Carlo W Cereda, Michael Mlynash, Nishant K Mishra, Manabu Inoue, Stephanie Kemp, Søren Christensen, Matus Straka, Greg Zaharchuk, Michael P Marks and 3 more

Registry-linked trialAbstract read
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In one paragraph

Article in Neurology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04558125 (Low-Dose Tenecteplase in Covid-19 Patients With Acute Pulmonary Embolism), which is not on this map. Cited by 43 papers.

0numbers the graph read from it
0cells of the map it votes in
43citing papers in PubMed
–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.

NCT04558125 phase4terminatednot on this mapstarted 2020, after this paper: background citation

Low-Dose Tenecteplase in Covid-19 Patients With Acute Pulmonary Embolism: A Randomized, Double-Blind, Placebo-Controlled Trial

TypeinterventionalSponsorCedars-Sinai Medical CenterRan2020 to 2021Enrolled2ConditionsPulmonary Embolism, COVIDArmsTNKase, Placebo, Enoxaparin
3 · Its place in the literature

Who cites it

43 citing papers in PubMed.

  1. Trial
  2. Trial
  3. A multicenter randomized controlled trial of endovascular therapy following imaging evaluation for ischemic stroke (DEFUSE 3).International journal of stroke : official journal of the International Stroke Society · 2017
    Trial
  4. Article
  5. Article
  6. Article
  7. Effect of MR-guided perfusion imaging mismatch profiles within 6 h on endovascular thrombectomy outcomes.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025
    Article
  8. Article
  9. Article
  10. Article
  11. Bringing door-to-needle times within the European benchmarks results in better stroke patients outcomes in a spoke hospital from the Apulian Region.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2023
    Article
  12. Article
  13. Observational
  14. Article
  15. Review
  16. Value of pre-intervention CT perfusion imaging in acute ischemic stroke prognosis.Diagnostic and interventional radiology (Ankara, Turkey) · 2021
    Article
  17. Article
  18. Fifty Years of Acute Ischemic Stroke Treatment: A Personal History.Cerebrovascular diseases (Basel, Switzerland) · 2021
    Review
  19. Article
  20. [Endovascular Treatment of Acute Ischemic Stroke].Taehan Yongsang Uihakhoe chi · 2020
    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

13 authors.

Maarten G LansbergFrom the Stanford Stroke Center (M.G.L., C.W.C., M.M., N.K.M., M.I., S.K., S.C., M.S., G.Z., M.P.M., R.B., G.W.A.), Department of Neurology, Stanford University, Palo Alto, CA; and Stroke Center (C.W.C.), Department of Neurology, Neurocenter (EOC) of Southern Switzerland, Lugano, Switzerland. lansberg@stanford.edu.
Carlo W CeredaFrom the Stanford Stroke Center (M.G.L., C.W.C., M.M., N.K.M., M.I., S.K., S.C., M.S., G.Z., M.P.M., R.B., G.W.A.), Department of Neurology, Stanford University, Palo Alto, CA; and Stroke Center (C.W.C.), Department of Neurology, Neurocenter (EOC) of Southern Switzerland, Lugano, Switzerland.
Michael MlynashFrom the Stanford Stroke Center (M.G.L., C.W.C., M.M., N.K.M., M.I., S.K., S.C., M.S., G.Z., M.P.M., R.B., G.W.A.), Department of Neurology, Stanford University, Palo Alto, CA; and Stroke Center (C.W.C.), Department of Neurology, Neurocenter (EOC) of Southern Switzerland, Lugano, Switzerland.
Nishant K MishraFrom the Stanford Stroke Center (M.G.L., C.W.C., M.M., N.K.M., M.I., S.K., S.C., M.S., G.Z., M.P.M., R.B., G.W.A.), Department of Neurology, Stanford University, Palo Alto, CA; and Stroke Center (C.W.C.), Department of Neurology, Neurocenter (EOC) of Southern Switzerland, Lugano, Switzerland.
Manabu InoueFrom the Stanford Stroke Center (M.G.L., C.W.C., M.M., N.K.M., M.I., S.K., S.C., M.S., G.Z., M.P.M., R.B., G.W.A.), Department of Neurology, Stanford University, Palo Alto, CA; and Stroke Center (C.W.C.), Department of Neurology, Neurocenter (EOC) of Southern Switzerland, Lugano, Switzerland.
Stephanie KempFrom the Stanford Stroke Center (M.G.L., C.W.C., M.M., N.K.M., M.I., S.K., S.C., M.S., G.Z., M.P.M., R.B., G.W.A.), Department of Neurology, Stanford University, Palo Alto, CA; and Stroke Center (C.W.C.), Department of Neurology, Neurocenter (EOC) of Southern Switzerland, Lugano, Switzerland.
Søren ChristensenFrom the Stanford Stroke Center (M.G.L., C.W.C., M.M., N.K.M., M.I., S.K., S.C., M.S., G.Z., M.P.M., R.B., G.W.A.), Department of Neurology, Stanford University, Palo Alto, CA; and Stroke Center (C.W.C.), Department of Neurology, Neurocenter (EOC) of Southern Switzerland, Lugano, Switzerland.
Matus StrakaFrom the Stanford Stroke Center (M.G.L., C.W.C., M.M., N.K.M., M.I., S.K., S.C., M.S., G.Z., M.P.M., R.B., G.W.A.), Department of Neurology, Stanford University, Palo Alto, CA; and Stroke Center (C.W.C.), Department of Neurology, Neurocenter (EOC) of Southern Switzerland, Lugano, Switzerland.
Greg ZaharchukFrom the Stanford Stroke Center (M.G.L., C.W.C., M.M., N.K.M., M.I., S.K., S.C., M.S., G.Z., M.P.M., R.B., G.W.A.), Department of Neurology, Stanford University, Palo Alto, CA; and Stroke Center (C.W.C.), Department of Neurology, Neurocenter (EOC) of Southern Switzerland, Lugano, Switzerland.
Michael P MarksFrom the Stanford Stroke Center (M.G.L., C.W.C., M.M., N.K.M., M.I., S.K., S.C., M.S., G.Z., M.P.M., R.B., G.W.A.), Department of Neurology, Stanford University, Palo Alto, CA; and Stroke Center (C.W.C.), Department of Neurology, Neurocenter (EOC) of Southern Switzerland, Lugano, Switzerland.
Roland BammerFrom the Stanford Stroke Center (M.G.L., C.W.C., M.M., N.K.M., M.I., S.K., S.C., M.S., G.Z., M.P.M., R.B., G.W.A.), Department of Neurology, Stanford University, Palo Alto, CA; and Stroke Center (C.W.C.), Department of Neurology, Neurocenter (EOC) of Southern Switzerland, Lugano, Switzerland.
Gregory W AlbersFrom the Stanford Stroke Center (M.G.L., C.W.C., M.M., N.K.M., M.I., S.K., S.C., M.S., G.Z., M.P.M., R.B., G.W.A.), Department of Neurology, Stanford University, Palo Alto, CA; and Stroke Center (C.W.C.), Department of Neurology, Neurocenter (EOC) of Southern Switzerland, Lugano, Switzerland.
Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution 2 (DEFUSE 2) Study Investigators

Funding

CTP to predict Response to recanalization in Ischemic Stroke Project (CRISP)R01NS075209 · NINDS · STANFORD UNIVERSITY · PI LANSBERG, MAARTEN G · 2011 to 2023
$6.0M
NINDS NIH HHS R01 NS03932505NINDS NIH HHS R01 NS075209PHS HHS 1ZIANS00
6 · The paper itself

Abstract

objectiveTo evaluate whether time to treatment modifies the effect of endovascular reperfusion in stroke patients with evidence of salvageable tissue on MRI.

methodsPatients from the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution 2 (DEFUSE 2) cohort study with a perfusion-diffusion target mismatch were included. Reperfusion was defined as a decrease in the perfusion lesion volume of at least 50% between baseline and early follow-up. Good functional outcome was defined as a modified Rankin Scale score ≤2 at day 90. Lesion growth was defined as the difference between the baseline and the early follow-up diffusion-weighted imaging lesion volumes.

resultsAmong 78 patients with the target mismatch profile (mean age 66 ± 16 years, 54% women), reperfusion was associated with increased odds of good functional outcome (adjusted odds ratio 3.7, 95% confidence interval 1.2-12, p = 0.03) and attenuation of lesion growth (p = 0.02). Time to treatment did not modify these effects (p value for the time × reperfusion interaction is 0.6 for good functional outcome and 0.3 for lesion growth). Similarly, in the subgroup of patients with reperfusion (n = 46), time to treatment was not associated with good functional outcome (p = 0.2).

conclusionThe association between endovascular reperfusion and improved functional and radiologic outcomes is not time-dependent in patients with a perfusion-diffusion mismatch. Proof that patients with mismatch benefit from endovascular therapy in the late time window should come from a randomized placebo-controlled trial.

Indexed as

Outcome Assessment, Health CareAgedAged, 80 and overCerebrovascular CirculationEndovascular ProceduresFemaleFollow-Up StudiesHumansMagnetic Resonance ImagingMaleMiddle AgedReperfusionStrokeTime Factors

Identifiers

PMID26224727
PMCPMC4553034

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Registered trials

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