Evidence map›Paper›PMID 29705773›Full record

SynthesisJournal of neurointerventional surgery2019

Direct mechanical thrombectomy in tPA-ineligible and -eligible patients versus the bridging approach: a meta-analysis.

Johannes Kaesmacher, Pasquale Mordasini, Marcel Arnold, Elena López-Cancio, Neus Cerdá, Tobias Boeckh-Behrens, Justus F Kleine, Mayank Goyal, Michael D Hill, Vitor Mendes Pereira and 3 more

Open access · hybridAbstract readComparative StudyMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Journal of neurointerventional surgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 51 papers, 14 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
51citing papers in PubMed, 14 pooled it
12.5field-weighted citation impact, top 1% 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

51 citing papers in PubMed, 14 syntheses or guidelines pooled it, 126 citations in OpenAlex.

  1. Mechanical thrombectomy alone versus with thrombolysis for ischemic stroke: A meta-analysis of randomized trials.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2026
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  4. Intravenous thrombolysis plus mechanical thrombectomy versus mechanical thrombectomy alone for acute ischemic stroke: A systematic review and updated meta-analysis of clinical trials.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2024
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  8. Efficacy and safety of endovascular treatment with or without intravenous alteplase in acute anterior circulation large vessel occlusion stroke: a meta-analysis of randomized controlled trials.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2022
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  17. Acute ischemic stroke patient factors associated with poor outcomes in patients with favorable collaterals and successful thrombectomy.Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association · 2025
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  19. Evolving of treatment options for cerebral infarction.World journal of clinical cases · 2024
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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 at 7 institutions in 5 countries.

Johannes KaesmacherDepartment of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
Pasquale MordasiniInstitute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
Marcel ArnoldDepartment of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
Elena López-CancioDepartment of Neurology, Stroke Unit Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain.
Neus CerdáBiostatistics Unit, Bioclever CRO, Barcelona, Spain.
Tobias Boeckh-BehrensInstitute of Diagnostic and Interventional Neuroradiology, Technical University Munich, Klinikum rechts der Isar, München, Germany.
Justus F KleineInstitute of Neuroradiology, Berlin, Germany.
Mayank GoyalDepartment of Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada.
Michael D HillDepartment of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
Vitor Mendes PereiraDivision of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
Jeffrey L SaverComprehensive Stroke Center, Geffen School of Medicine, University of California, Los Angeles, California, USA.
Jan GrallaInstitute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
Urs FischerDepartment of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
University of Bern · CHUniversity Hospital of Bern · CHUniversity of Calgary · CAHospital Universitario Central de Asturias · ESKlinikum rechts der Isar · DEToronto Western Hospital · CAUniversity of California, Los Angeles · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundWhether pretreatment with intravenous thrombolysis prior to mechanical thrombectomy (IVT+MTE) adds additional benefit over direct mechanical thrombectomy (dMTE) in patients with large vessel occlusions (LVO) is a matter of debate.

methodsThis study-level meta-analysis was presented in accord with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled effect sizes were calculated using the inverse variance heterogeneity model and displayed as summary Odds Ratio (sOR) and corresponding 95% confidence interval (95% CI). Sensitivity analysis was performed by distinguishing between studies including dMTE patients eligible for IVT (IVT-E) or ineligible for IVT (IVT-IN). Primary outcome measures were functional independence (modified Rankin Scale≤2) and mortality at day 90, successful reperfusion, and symptomatic intracerebral hemorrhage.

resultsTwenty studies, incorporating 5279 patients, were included. There was no evidence that rates of successful reperfusion differed in dMTE and IVT+MTE patients (sOR 0.93, 95% CI 0.68 to 1.28). In studies including IVT-IN dMTE patients, patients undergoing dMTE tended to have lower rates of functional independence and had higher odds for a fatal outcome as compared with IVT+MTE patients (sOR 0.78, 95% CI 0.61 to 1.01 and sOR 1.45, 95% CI 1.22 to 1.73). However, no such treatment group effect was found when analyses were confined to cohorts with a lower risk of selection bias (including IVT-E dMTE patients).

conclusionThe quality of evidence regarding the relative merits of IVT+MTE versus dMTE is low. When considering studies with lower selection bias, the data suggest that dMTE may offer comparable safety and efficacy as compared with IVT+MTE. The conduct of randomized-controlled clinical trials seems justified.

Indexed as

Administration, IntravenousBrain IschemiaCerebral HemorrhageFibrinolytic AgentsHumansMechanical ThrombolysisRandomized Controlled Trials as TopicReperfusionStrokeThrombectomyThrombolytic TherapyTissue Plasminogen ActivatorTreatment OutcomeFibrinolytic AgentsTissue Plasminogen Activatorstrokethrombectomythrombolysis

Identifiers

PMID29705773
PMCPMC6327861
OpenAlexW2800475142

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
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.