Evidence map›Paper›PMID 27756804›Full record

Trial reportJournal of neurology, neurosurgery, and psychiatry2017

Endovascular therapy for acute ischaemic stroke: the Pragmatic Ischaemic Stroke Thrombectomy Evaluation (PISTE) randomised, controlled trial.

Keith W Muir, Gary A Ford, Claudia-Martina Messow, Ian Ford, Alicia Murray, Andrew Clifton, Martin M Brown, Jeremy Madigan, Rob Lenthall, Fergus Robertson and 6 more

2 registry-linked trialsAbstract readMulticenter StudyRandomized Controlled TrialPragmatic Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of neurology, neurosurgery, and psychiatry, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 127 papers, 21 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
127citing papers in PubMed, 21 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.

NCT01745692 naterminatednot on this map

A Randomised Controlled Clinical Trial of Adjunctive Mechanical Thrombectomy Compared With Intravenous Thrombolysis in Patients With Acute Ischaemic Stroke Due to an Occluded Major Intracranial Vessel.

TypeinterventionalSponsorNHS Greater Glasgow and ClydeRan2012 to 2015Enrolled65ConditionsAcute Ischaemic StrokeArmsMechanical thrombectomy, Intravenous rtPA
NCT06721338 phase1terminatednot on this mapstarted 2025, after this paper: background citation

Safety and Efficacy of Mechanical Thrombectomy Utilizing Reversal Flow

TypeinterventionalSponsorMediSys Health NetworkRan2025 to 2025Enrolled3ConditionsStroke, Large Vessel OcclusionArmsMechanical thrombectomy via blood flow reversal using BOBBY balloon guide catheter
3 · Its place in the literature

Who cites it

127 citing papers in PubMed, 21 syntheses or guidelines pooled it.

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  7. Mechanical thrombectomy with retrievable stents and aspiration catheters for acute ischaemic stroke: a meta-analysis of randomised controlled trials.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2022
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  16. Analysis of revascularisation in ischaemic stroke with EmboTrap (ARISE I study) and meta-analysis of thrombectomy.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2019
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67 more citing papers are in PubMed but not listed here.

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

16 authors.

Keith W MuirInstitute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK.
Gary A FordDivision of Medical Sciences, Oxford University Hospitals NHS Trust, Oxford University, Oxford, UK.
Claudia-Martina MessowRobertson Centre for Biostatistics, University of Glasgow, Glasgow, UK.
Ian FordRobertson Centre for Biostatistics, University of Glasgow, Glasgow, UK.
Alicia MurrayInstitute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK.
Andrew CliftonSt George's, University of London, London, UK.
Martin M BrownStroke Research Centre, UCL Institute of Neurology, University College London, London, UK.
Jeremy MadiganSt George's, University of London, London, UK.
Rob LenthallDepartment of Neuroradiology, Queen's Medical Centre, Nottingham, UK.
Fergus RobertsonStroke Research Centre, UCL Institute of Neurology, University College London, London, UK.
Anand DixitInstitute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.
Geoffrey C CloudSt George's, University of London, London, UK.
Joanna WardlawBrain Research Imaging Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
Janet FreemanLay member, Cornwall, UK.
Philip WhiteInstitute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.
PISTE Investigators

Funding

Department of Health HTA/14/08/47Medical Research Council MR/K026992/1Medical Research Council MR/N003403/1
6 · The paper itself

Abstract

objectiveThe Pragmatic Ischaemic Thrombectomy Evaluation (PISTE) trial was a multicentre, randomised, controlled clinical trial comparing intravenous thrombolysis (IVT) alone with IVT and adjunctive intra-arterial mechanical thrombectomy (MT) in patients who had acute ischaemic stroke with large artery occlusive anterior circulation stroke confirmed on CT angiography (CTA).

designEligible patients had IVT started within 4.5 hours of stroke symptom onset. Those randomised to additional MT underwent thrombectomy using any Conformité Européene (CE)-marked device, with target interval times for IVT start to arterial puncture of <90 min. The primary outcome was the proportion of patients achieving independence defined by a modified Rankin Scale (mRS) score of 0-2 at day 90.

resultsTen UK centres enrolled 65 patients between April 2013 and April 2015. Median National Institutes of Health Stroke Scale score was 16 (IQR 13-21). Median stroke onset to IVT start was 120 min. In the intention-to-treat analysis, there was no significant difference in disability-free survival at day 90 with MT (absolute difference 11%, adjusted OR 2.12, 95% CI 0.65 to 6.94, p=0.20). Secondary analyses showed significantly greater likelihood of full neurological recovery (mRS 0-1) at day 90 (OR 7.6, 95% CI 1.6 to 37.2, p=0.010). In the per-protocol population (n=58), the primary and most secondary clinical outcomes significantly favoured MT (absolute difference in mRS 0-2 of 22% and adjusted OR 4.9, 95% CI 1.2 to 19.7, p=0.021).

conclusionsThe trial did not find a significant difference between treatment groups for the primary end point. However, the effect size was consistent with published data and across primary and secondary end points. Proceeding as fast as possible to MT after CTA confirmation of large artery occlusion on a background of intravenous alteplase is safe, improves excellent clinical outcomes and, in the per-protocol population, improves disability-free survival. TRIAL REGISTRATION NUMBER: NCT01745692; Results.

Indexed as

ThrombectomyThrombolytic TherapyAdministration, IntravenousAgedAged, 80 and overBrain IschemiaCombined Modality TherapyFemaleHumansMaleMiddle AgedStrokeSurvival AnalysisTissue Plasminogen ActivatorTreatment OutcomeTissue Plasminogen Activator

Identifiers

PMID27756804
PMCPMC5256149

What OpenQuestion holds

Textmetadata
LicenceCC BY
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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.