Evidence map›Paper›PMID 37010551›Full record

ArticleClinical neuroradiology2023

Specialist Perspectives on the Imaging Selection of Large Vessel Occlusion in the Late Window.

Piers Klein, Xiaochuan Huo, Yimin Chen, Mohamad Abdalkader, Zhongming Qiu, Simon Nagel, Jean Raymond, Liping Liu, James E Siegler, Daniel Strbian and 66 more

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Clinical neuroradiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
3.0field-weighted citation impact, top 8% 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

6 citing papers in PubMed, 14 citations in OpenAlex.

  1. Visual Alberta stroke program early computed tomography score versus RAPID-AI perfusion in predicting outcome after late-window thrombectomy.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2025
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  2. Observational
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  5. Review
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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

76 authors at 20 institutions in 22 countries.

Piers KleinNeurology, Boston Medical Center, Boston, USA.
Xiaochuan HuoInterventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China.
Yimin ChenNeurology, Foshan Sanshui District People's Hospital, Foshan, China.
Mohamad AbdalkaderRadiology, Boston Medical Center, Boston, USA.
Zhongming QiuNeurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China.
Simon NagelNeurology, Klinikum Ludwigshafen, Ludwigshafen, Germany.
Jean RaymondInterventional Neuroradiology, Centre Hospitalier de l'Universite de Montreal, Montreal, Canada.
Liping LiuNeurology, Beijing Tiantan Hospital, Beijing, China.
James E SieglerCooper Neurological Institute, Camden, USA.
Daniel StrbianNeurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Thalia S FieldNeurology, University of British Columbia, Vancouver, Canada.
Shadi YaghiNeurology, Rhode Island Hospital, Providence, USA.
Muhammad M QureshiRadiology, Boston Medical Center, Boston, USA.
Jelle DemeestereNeurology, Leuven University Hospital, Leuven, Belgium.
Volker PuetzDepartment of Neurology, University Hospital Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany.
Anne BerberichNeurology, Klinikum Ludwigshafen, Ludwigshafen, Germany.
Patrik MichelStroke Center/Neurology, Lausanne University Hospital, Lausanne, Switzerland.
Urs FischerNeurology, Basel University Hospital, Basel, Switzerland.
Johannes KaesmacherDiagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland.
Hiroshi YamagamiNeurology, Osaka National Hospital, Osaka, Japan.
Fana AlemsegedRoyal Melbourne Hospital, Melbourne, Australia.
Georgios TsivgoulisNeurology, Attikon University Hospital, Athens, Greece.
Wouter J SchonewilleNeurology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Wei HuStroke Center, The First Affiliated Hospital of USTC, Hefei, China.
Xinfeng LiuStroke Center, The First Affiliated Hospital of USTC, Hefei, China.
Chuanhui LiNeurology, Xuanwu Hospital, Beijing, China.
Xunming JiNeurosurgery, Xuanwu Hospital, Beijing, China.
Brian DrummStroke Medicine, Imperial College Healthcare, London, UK.
Soma BanerjeeStroke Medicine, Imperial College Healthcare, London, UK.
Simona SaccoBiotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
Else C SandsetNeurology, Oslo University Hospital, Oslo, Norway.
Espen Saxhaug KristoffersenNeurology, Akershus University Hospital, Akershus, Norway.
Peter SladeMorriston Hospital, Swansea Hospital, Swansea, Wales, UK.
Robert MikulikNeurology, St Anne's University Hospital, Brno, Czech Republic.
Michele RomoliNeurology, Bufalini Hospital, Cesena, Italy.
Francesco DianaNeuroradiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy.
Kailash KrishnanStroke, Department of Acute Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Permesh DhillonInterventional Neuroradiology, Nottingham University Hospitals, Nottingham, UK.
Jin Soo LeeNeurology, Ajou University Hospital, Suwon, Korea (Republic of).
Ekkehard KasperNeurosurgery, Boston Medical Center, Boston, USA.
Hormuzdiyar DasenbrockNeurosurgery, Boston Medical Center, Boston, USA.
Mai Duy TonStroke Center, Bach Mai Hospital, Hanoi, Viet Nam.
Rytis MasiliūnasCenter of Neurology, Vilnius University, Vilnius, Lithuania.
Anita Ante ArsovskaUrgent Neurology, University Clinic of Neurology, Skopje, Macedonia.
João Pedro MartoNeurology, Hospital de Egas Moniz, Lisbon, Portugal.
Adam A DmytriwNeurointerventional, London Health Sciences Centre, London, Canada.
Robert W RegenhardtNeuroendovascular, Massachusetts General Hospital, Boston, USA.
Gisele Sampaio SilvaUniversidade Federal de São Paulo (UNIFESP) and Hospital Israelita Albert Einstein, São Paulo, Brazil.
Timo SiepmannDepartment of Neurology, University Hospital Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany.
Dapeng SunInterventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China.
Hongfei SangNeurology, Affiliated Hangzhou First People's Hospital, Hangzhou, China.
Jose Danilo DiestroDiagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Canada.
Pengfei YangNeurosurgery, Changhai Hospital, Shanghai, China.
Mahmoud H MohammadenNeurology, Emory University, Atlanta, USA.
Fengli LiDepartment of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, China.
Hesham E MasoudNeurology, SUNY Upstate, Syracuse, USA.
Alice MaRoyal North Shore Hospital, Sydney, Australia.
RaynaldInterventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China.
Aravind GaneshNeurology, University of Calgary, Calgary, Canada.
Jianmin LiuNeurosurgery, Changhai Hospital, Shanghai, China.
Lukas MeyerInterventionelle Neuroradiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
Diederik W J DippelNeurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Götz ThomallaKlinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
Mark ParsonsSouth Western Sydney Clinical School, Liverpool Hospital, Liverpool, Australia.
Adnan I QureshiZeenat Qureshi Stroke Institute, University of Missouri, Columbia, USA.
Mayank GoyalRadiology, University of Calgary, Calgary, Canada.
Albert J YooNeurointervention, Texas Stroke Institute, Dallas-Fort Worth, USA.
Bertrand LapergueNeurology, Hopital Foch, Suresnes, France.
Osama O ZaidatNeuroscience, Mercy Health St Vincent Hospital, Toledo, OH, USA.
Hui-Sheng ChenNeurology, General Hospital of Northern Theatre Command, Shenyang, China.
Bruce C V CampbellRoyal Melbourne Hospital, Melbourne, Australia.
Tudor G JovinCooper Neurological Institute, Camden, USA.
Raul G NogueiraNeurology, University of Pittsburgh Medical Center, Pittsburgh, USA.
Zhongrong MiaoInterventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China.
Gustavo SaposnikStroke Outcomes and Decision Neuroscience Research Unit, University of Toronto, Toronto, Canada.
Thanh N NguyenNeurology, Boston Medical Center, Boston, USA. Thanh.Nguyen@bmc.org.ORCID http://orcid.org/0000-0002-2810-1685
Boston University · USBeijing Xuanwu Traditional Chinese Medicine Hospital · CNCooper University Hospital · USImperial College Healthcare NHS Trust · GBNottingham University Hospitals NHS Trust · GBSecond Military Medical University · CNSoochow University · CNThe Royal Melbourne Hospital · AUUniversität Hamburg · DEUniversity Hospital Carl Gustav Carus · DEUniversity of Calgary · CA117th Hospital of People's Liberation Army · CNAjou University Hospital · KRAkershus University Hospital · NOArmy Medical University · CNBeijing Tian Tan Hospital · CNCentre Hospitalier de l’Université de Montréal · CAEmory University · USErasmus MC · NLFederal Reserve Bank of Dallas · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe proper imaging modality for use in the selection of patients for endovascular thrombectomy (EVT) presenting in the late window remains controversial, despite current guidelines advocating the use of advanced imaging in this population. We sought to understand if clinicians with different specialty training differ in their approach to patient selection for EVT in the late time window.

methodsWe conducted an international survey of stroke and neurointerventional clinicians between January and May 2022 with questions focusing on imaging and treatment decisions of large vessel occlusion (LVO) patients presenting in the late window. Interventional neurologists, interventional neuroradiologists, and endovascular neurosurgeons were defined as interventionists whereas all other specialties were defined as non-interventionists. The non-interventionist group was defined by all other specialties of the respondents: stroke neurologist, neuroradiologist, emergency medicine physician, trainee (fellows and residents) and others.

resultsOf 3000 invited to participate, 1506 (1027 non-interventionists, 478 interventionists, 1 declined to specify) physicians completed the study. Interventionist respondents were more likely to proceed directly to EVT (39.5% vs. 19.5%; p < 0.0001) compared to non-interventionist respondents in patients with favorable ASPECTS (Alberta Stroke Program Early CT Score). Despite no difference in access to advanced imaging, interventionists were more likely to prefer CT/CTA alone (34.8% vs. 21.0%) and less likely to prefer CT/CTA/CTP (39.1% vs. 52.4%) for patient selection (p < 0.0001). When faced with uncertainty, non-interventionists were more likely to follow clinical guidelines (45.1% vs. 30.2%) while interventionists were more likely to follow their assessment of evidence (38.7% vs. 27.0%) (p < 0.0001).

conclusionInterventionists were less likely to use advanced imaging techniques in selecting LVO patients presenting in the late window and more likely to base their decisions on their assessment of evidence rather than published guidelines. These results reflect gaps between interventionists and non-interventionists reliance on clinical guidelines, the limits of available evidence, and clinician belief in the utility of advanced imaging.

Indexed as

Brain IschemiaEndovascular ProceduresStrokeComputed Tomography AngiographyHumansThrombectomyTomography, X-Ray ComputedTreatment OutcomeASPECTSEndovascular thrombectomyLarge vessel occlusionLate windowMechanical thrombectomy

Identifiers

PMID37010551
PMCPMC10069362
OpenAlexW4362506101

What OpenQuestion holds

Textmetadata
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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.