ArticleJAMA neurology2019
Mediation of the Relationship Between Endovascular Therapy and Functional Outcome by Follow-up Infarct Volume in Patients With Acute Ischemic Stroke.
Article in JAMA neurology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 69 papers, 5 of them syntheses that pooled 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.
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.
Who cites it
69 citing papers in PubMed, 5 syntheses or guidelines pooled it, 124 citations in OpenAlex.
- Bridging thrombolysis versus direct thrombectomy in acute ischemic stroke with large vessel occlusion: a network meta-analysis.Journal of neurology · 2025Pooled it
- Intensive versus less intensive blood pressure targets after mechanical thrombectomy in acute ischemic stroke: a systematic review and network meta-analysis.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025Pooled it
- Cerebral Edema in Patients With Large Hemispheric Infarct Undergoing Reperfusion Treatment: A HERMES Meta-Analysis.Stroke · 2021Pooled it
- Infarct Growth despite Successful Endovascular Reperfusion in Acute Ischemic Stroke: A Meta-analysis.AJNR. American journal of neuroradiology · 2021Pooled it
- Prognostic value of neutrophil to lymphocyte ratio in acute ischemic stroke after reperfusion therapy.Scientific reports · 2021Pooled it
- Reperfusion-dependent treatment effects of thrombectomy in patients with large ischemic infarcts.International journal of stroke : official journal of the International Stroke Society · 2026Trial
- Impact of Minimally Invasive Surgery on Midline Shift and Outcomes in Large Supratentorial Spontaneous Intracerebral Hemorrhage: Post Hoc Analysis of MISTIE III.Neurocritical care · 2026Trial
- Association of Minimal Clinically Important Difference With Infarct Volume in Clinical Poststroke Outcomes.Journal of the American Heart Association · 2025Trial
- Unsuccessful Recanalization versus Medical Management of Patients with Large Ischemic Core : Analysis of the ANGEL-ASPECT Randomized Trial.Clinical neuroradiology · 2024Trial
- Effect of Endovascular Thrombectomy for Acute Ischemic Stroke on Cognitive Outcomes: A Secondary Analysis of the ESCAPE Trial.Neurology · 2024Trial
- Trial
- Association of Tirofiban With Functional Outcomes After Thrombectomy in Acute Ischemic Stroke Due to Intracranial Atherosclerotic Disease.Neurology · 2023Trial
- Infarct Evolution in Patients with Anterior Circulation Large-Vessel Occlusion Randomized to IV Alteplase and Endovascular Treatment versus Endovascular Treatment Alone.AJNR. American journal of neuroradiology · 2023Trial
- Strength of Association between Infarct Volume and Clinical Outcome Depends on the Magnitude of Infarct Size: Results from the ESCAPE-NA1 Trial.AJNR. American journal of neuroradiology · 2021Trial
- Preserved structural connectivity mediates the clinical effect of thrombolysis in patients with anterior-circulation stroke.Nature communications · 2021Trial
- Effect of withholding early parenteral nutrition in PICU on ketogenesis as potential mediator of its outcome benefit.Critical care (London, England) · 2020Trial
- Trial
- A roadmap towards clinical use of molecular biomarkers in acute ischaemic stroke.Nature reviews. Neurology · 2026Review
- Refining reperfusion assessment with flat-panel detector CT: association with final infarct volume after endovascular thrombectomy.European stroke journal · 2026Article
- Final Infarct Volume as a Surrogate End Point in Anterior Circulation ICAS-LVO Stroke: Post Hoc Secondary Analysis of RESCUE-ICAS.Stroke (Hoboken, N.J.) · 2026Article
9 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
52 authors at 20 institutions in 10 countries.
Funding
Abstract
Importance: The positive treatment effect of endovascular therapy (EVT) is assumed to be caused by the preservation of brain tissue. It remains unclear to what extent the treatment-related reduction in follow-up infarct volume (FIV) explains the improved functional outcome after EVT in patients with acute ischemic stroke. Objective: To study whether FIV mediates the relationship between EVT and functional outcome in patients with acute ischemic stroke. Design, Setting, and Participants: Patient data from 7 randomized multicenter trials were pooled. These trials were conducted between December 2010 and April 2015 and included 1764 patients randomly assigned to receive either EVT or standard care (control). Follow-up infarct volume was assessed on computed tomography or magnetic resonance imaging after stroke onset. Mediation analysis was performed to examine the potential causal chain in which FIV may mediate the relationship between EVT and functional outcome. A total of 1690 patients met the inclusion criteria. Twenty-five additional patients were excluded, resulting in a total of 1665 patients, including 821 (49.3%) in the EVT group and 844 (50.7%) in the control group. Data were analyzed from January to June 2017. Main Outcome and Measure: The 90-day functional outcome via the modified Rankin Scale (mRS). Results: Among 1665 patients, the median (interquartile range [IQR]) age was 68 (57-76) years, and 781 (46.9%) were female. The median (IQR) time to FIV measurement was 30 (24-237) hours. The median (IQR) FIV was 41 (14-120) mL. Patients in the EVT group had significantly smaller FIVs compared with patients in the control group (median [IQR] FIV, 33 [11-99] vs 51 [18-134] mL; P = .007) and lower mRS scores at 90 days (median [IQR] score, 3 [1-4] vs 4 [2-5]). Follow-up infarct volume was a predictor of functional outcome (adjusted common odds ratio, 0.46; 95% CI, 0.39-0.54; P < .001). Follow-up infarct volume partially mediated the relationship between treatment type with mRS score, as EVT was still significantly associated with functional outcome after adjustment for FIV (adjusted common odds ratio, 2.22; 95% CI, 1.52-3.21; P < .001). Treatment-reduced FIV explained 12% (95% CI, 1-19) of the relationship between EVT and functional outcome. Conclusions and Relevance: In this analysis, follow-up infarct volume predicted functional outcome; however, a reduced infarct volume after treatment with EVT only explained 12% of the treatment benefit. Follow-up infarct volume as measured on computed tomography and magnetic resonance imaging is not a valid proxy for estimating treatment effect in phase II and III trials of acute ischemic stroke.
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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.