Evidence map›Paper›PMID 31597552›Full record

Trial reportStroke2019

Thrombus Migration Paradox in Patients With Acute Ischemic Stroke.

Heitor C Alves, Kilian M Treurniet, Ivo G H Jansen, Albert J Yoo, Bruna G Dutra, Guang Zhang, Lonneke Yo, Adriaan C G M van Es, Bart J Emmer, René van den Berg and 7 more

Open access · greenAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Stroke, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 49 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
49citing papers in PubMed, 6 pooled it
8.3field-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.

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

49 citing papers in PubMed, 6 syntheses or guidelines pooled it, 97 citations in OpenAlex.

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  3. 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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  5. 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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  12. ADJUVANT Randomized Controlled Trial: Rationale and Design.Journal of the American Heart Association · 2026
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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

17 authors at 6 institutions in 1 country.

Heitor C AlvesFrom the Departments of Radiology and Nuclear Medicine (H.C.A., K.M.T, I.G.H.J., B.G.D., G.Z., B.J.E., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands.
Kilian M TreurnietFrom the Departments of Radiology and Nuclear Medicine (H.C.A., K.M.T, I.G.H.J., B.G.D., G.Z., B.J.E., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands.
Ivo G H JansenFrom the Departments of Radiology and Nuclear Medicine (H.C.A., K.M.T, I.G.H.J., B.G.D., G.Z., B.J.E., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands.
Albert J YooDivision of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.).
Bruna G DutraFrom the Departments of Radiology and Nuclear Medicine (H.C.A., K.M.T, I.G.H.J., B.G.D., G.Z., B.J.E., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands.
Guang ZhangFrom the Departments of Radiology and Nuclear Medicine (H.C.A., K.M.T, I.G.H.J., B.G.D., G.Z., B.J.E., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands.
Lonneke YoDepartment of Radiology, Catharina Ziekenhuis, Eindhoven, the Netherlands (L.Y.).
Adriaan C G M van EsDepartment of Radiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands (A.C.G.M.v.E.).
Bart J EmmerFrom the Departments of Radiology and Nuclear Medicine (H.C.A., K.M.T, I.G.H.J., B.G.D., G.Z., B.J.E., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands.
René van den BergFrom the Departments of Radiology and Nuclear Medicine (H.C.A., K.M.T, I.G.H.J., B.G.D., G.Z., B.J.E., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands.
Ido R van den WijngaardDepartments of Neurology (I.R.v.d.W), Haaglanden Medical Center, The Hague, the Netherlands.
Geert J Lycklama À NijeholtRadiology (G.J.L.a.N.), Haaglanden Medical Center, The Hague, the Netherlands.
Jan-Albert VosDepartment of Radiology, St Antonius Ziekenhuis, Nieuwegein, the Netherlands (J.A.V).
Yvo B W E M RoosNeurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands.
Wouter SchonewilleDepartment of Neurology, University Medical Center, Utrecht, the Netherlands (W.S.).
Henk A MarqueringBiomedical Engineering and Physics (H.C.A., B.G.D., H.A.M.), Academic Medical Center, Amsterdam, the Netherlands.
Charles B L M MajoieFrom the Departments of Radiology and Nuclear Medicine (H.C.A., K.M.T, I.G.H.J., B.G.D., G.Z., B.J.E., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands.
Academic Medical Center · NLMedisch Centrum Haaglanden · NLErasmus MC · NLRadboud University Nijmegen · NLSt. Antonius Ziekenhuis · NLUniversity Medical Center Utrecht · NL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background and Purpose- The location of the thrombus as observed on first digital subtraction angiography during endovascular treatment may differ from the initial observation on initial noninvasive imaging. We studied the incidence of thrombus dynamics, its impact on patient outcomes, and its association with intravenous thrombolytics. Methods- We included patients from the MR CLEAN registry (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke) with an initial target occlusion on computed tomography angiography located in the intracranial internal carotid artery, M1, or M2. The conventional angiography target occlusion was defined during endovascular treatment. Thrombus dynamics were classified as growth, stability, migration, and resolution. The primary outcome was functional outcome at 90 days (modified Rankin Scale). The secondary outcomes were successful and complete reperfusion (extended treatment in cerebral infarction scores of 2b-3 and 3, respectively). Results- The analysis included 1349 patients. Thrombus migration occurred in 302 (22%) patients, thrombus growth in 87 (6%), and thrombus resolution in 39 (3%). Intravenous treatment with alteplase was associated with more thrombus migration (adjusted odds ratio, 2.01; CI, 1.29-3.11) and thrombus resolution (adjusted odds ratio, 1.85; CI, 1.22-2.80). Thrombus migration was associated with a lower chance of complete reperfusion (adjusted odds ratio, 0.57; CI, 0.42-0.78) and successful reperfusion (adjusted odds ratio, 0.74; CI, 0.55-0.99). In the subgroup of patients with M1 initial target occlusion, thrombus migration was associated with better functional outcome (adjusted common odds ratio, 1.49; CI, 1.02-2.17), and there was a trend towards better functional outcome in patients with thrombus resolution (adjusted common odds ratio, 2.23; CI, 0.93-5.37). Conclusions- In patients with acute ischemic stroke, thrombus location regularly changes between computed tomography angiography and digital subtraction angiography. Administration of intravenous alteplase increases the chance of thrombus migration and resolution. Thrombus migration is associated with better functional outcome but reduces the rate of complete reperfusion.

Indexed as

Brain IschemiaCarotid Artery, InternalComputed Tomography AngiographyRegistriesStrokeThrombosisTissue Plasminogen ActivatorAcute DiseaseAgedAged, 80 and overFemaleHumansMaleMiddle AgedTissue Plasminogen Activatorangiographycerebral infarctioncomputed tomography angiographyinternal carotid arteryworkflow

Identifiers

PMID31597552
PMCPMC6824579
OpenAlexW2980095488

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

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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.