Evidence map›Paper›PMID 35232755›Full record

ArticleJournal of neurointerventional surgery2023

Perceived acceptable uncertainty regarding comparability of endovascular treatment alone versus intravenous thrombolysis plus endovascular treatment.

Johannes Kaesmacher, Adnan Mujanovic, Kilian Treurniet, Manon Kappelhof, Thomas R Meinel, Pengfei Yang, Jianmin Liu, Yongwei Zhang, Wenjie Zi, Qingwu Yang and 12 more

Open access · hybridAbstract readEquivalence Trial
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of neurointerventional surgery, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 2 pooled it
1.2field-weighted citation impact, top 22% 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

4 citing papers in PubMed, 2 syntheses or guidelines pooled it, 11 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. ADJUVANT Randomized Controlled Trial: Rationale and Design.Journal of the American Heart Association · 2026
    Article
  4. 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

22 authors at 9 institutions in 6 countries.

Johannes KaesmacherDepartment for Diagnostic and Interventional Neuroradiology, Inselspital University Hospital Bern, Bern, Switzerland johannes.kaesmacher@insel.ch.ORCID http://orcid.org/0000-0002-9177-2289
Adnan MujanovicDepartment for Diagnostic and Interventional Neuroradiology, Inselspital University Hospital Bern, Bern, Switzerland.ORCID http://orcid.org/0000-0002-6839-7134
Kilian TreurnietDepartment of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands.
Manon KappelhofDepartment of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands.
Thomas R MeinelDepartment of Neurology, Inselspital University Hospital Bern, Bern, Switzerland.ORCID http://orcid.org/0000-0002-0647-9273
Pengfei YangNeurovascular Center, Naval Medical University, Shanghai, China.
Jianmin LiuNeurovascular Center, Naval Medical University, Shanghai, China.
Yongwei ZhangNeurovascular Center, Naval Medical University, Shanghai, China.
Wenjie ZiDepartment of Neurology, Army Medical University Xinqiao Hospital, Chongqing, Sichuan, China.
Qingwu YangDepartment of Neurology, Army Medical University Xinqiao Hospital, Chongqing, Sichuan, China.
Raul G NogueiraDepartment of Neurology, Grady Memorial Hospital, Chickasha, Oklahoma, USA.
Kazumi KimuraDepartment of Neurology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan.
Yuji MatsumaruDivision of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Kentaro SuzukiDepartment of Neurology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan.
Bernard YanMelbourne Brain Centre, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
Peter J MitchellDepartment of Radiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
Zhongrong MiaoDepartment of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China.
Yvo B W E M RoosDepartment of Neurology, Amsterdam University Medical Centres, Amsterdam, The Netherlands.
Charles B L M MajoieDepartment of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands.
Jan GrallaDepartment for Diagnostic and Interventional Neuroradiology, Inselspital University Hospital Bern, Bern, Switzerland.
Jeffrey L SaverDepartment of Neurology, UCLA, Los Angeles, California, USA.
Urs FischerDepartment of Neurology, Inselspital University Hospital Bern, Bern, Switzerland.
Amsterdam University Medical Centers · NLUniversity Hospital of Bern · CHArmy Medical University · CNNippon Medical School · JPThe Royal Melbourne Hospital · AUBeijing Tian Tan Hospital · CNGrady Memorial Hospital · USUniversity of Bern · CHUniversity of Tsukuba · JP

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMost trials comparing endovascular treatment (EVT) alone versus intravenous thrombolysis with alteplase (IVT) + EVT in directly admitted patients with a stroke are non-inferiority trials. However, the margin based on the level of uncertainty regarding non-inferiority of the experimental treatment that clinicians are willing to accept to incorporate EVT alone into clinical practice remains unknown.

objectiveTo characterize what experienced stroke clinicians would consider an acceptable level of uncertainty for hypothetical decisions on whether to administer IVT or not before EVT in patients admitted directly to EVT-capable centers.

methodsA web-based, structured survey was distributed to a cross-section of 600 academic neurologists/neurointerventionalists. For this purpose, a response framework for a hypothetical trial comparing IVT+EVT (standard of care) with EVT alone (experimental arm) was designed. In this trial, a similar proportion of patients in each arm achieved functional independence at 90 days. Invited physicians were asked at what level of certainty they would feel comfortable skipping IVT in clinical practice, considering these hypothetical trial results.

resultsThere were 180 respondents (response rate: 30%) and 165 with complete answers. The median chosen acceptable uncertainty suggesting reasonable comparability between both treatments was an absolute difference in the rate of day 90 functional independence of 3% (mode 5%, IQR 1-5%), with higher chosen margins observed in interventionalists (aOR 2.20, 95% CI 1.06 to 4.67).

conclusionPhysicians would generally feel comfortable skipping IVT before EVT at different certainty thresholds. Most physicians would treat with EVT alone if randomized trial data suggested that the number of patients achieving functional independence at 90 days was similar between the two groups, and one could be sufficiently sure that no more than 3 out of 100 patients would not achieve functional independence at 90 days due to skipping IVT.

Indexed as

Brain IschemiaEndovascular ProceduresStrokeFibrinolytic AgentsHumansThrombectomyThrombolytic TherapyTreatment OutcomeUncertaintyFibrinolytic Agentsstrokethrombectomythrombolysis

Identifiers

PMID35232755
PMCPMC9985721
OpenAlexW4214636330

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.