Evidence map›Paper›PMID 38409874›Full record

Trial reportEuropean journal of neurology2024

Value of intravenous alteplase before thrombectomy among patients with tandem lesions and emergent carotid artery stenting: A subgroup analysis of the SWIFT DIRECT trial.

Adnan Mujanovic, Tomas Dobrocky, Waltraud Pfeilschifter, Luca Remonda, Jildaz Caroff, Daniel Behme, David J Seiffge, Carlo W Cereda, Georg Kägi, Joe Leyon and 13 more

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in European journal of neurology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 2 pooled it
–field-weighted citation impact
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

5 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Trial
  4. Review
  5. Article
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

23 authors.

Adnan MujanovicDepartment of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, University of Bern, Bern, Switzerland.ORCID https://orcid.org/0000-0002-6839-7134
Tomas DobrockyDepartment of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, University of Bern, Bern, Switzerland.
Waltraud PfeilschifterDepartment of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.
Luca RemondaDepartment of Neuroradiology, Cantonal Hospital Aarau, Aarau, Switzerland.
Jildaz CaroffDepartment of Interventional Neuroradiology, NEURI Brain Vascular Center, Bicêtre Hospital, Paris-Saclay University, Le Kremlin-Bicêtre, France.
Daniel BehmeDepartment for Neuroradiology, Otto von Guericke University Hospital Magdeburg, University of Magdeburg, Magdeburg, Germany.
David J SeiffgeDepartment of Neurology, University Hospital Bern Inselspital, University of Bern, Bern, Switzerland.ORCID https://orcid.org/0000-0003-3890-3849
Carlo W CeredaStroke Center, Neurology, Neurocenter of Southern Switzerland (EOC), Lugano, Switzerland.
Georg KägiDepartment of Neurology, Cantonal Hospital St. Gallen, University of St. Gallen, St. Gallen, Switzerland.
Joe LeyonDepartment of Neuroradiology, St. George's University Hospital, London, UK.
Eike I PiechowiakDepartment of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, University of Bern, Bern, Switzerland.
Vincent CostalatDepartment of Neuroradiology, University Hospital Montpellier, Montpellier, France.
Judith WagnerDepartment of Neurology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria.
Emmanuel ChabertDepartment of Neuroradiology, University Hospital Clermont-Ferrand, Clermont-Ferrand, France.
Thomas R MeinelDepartment of Neurology, University Hospital Bern Inselspital, University of Bern, Bern, Switzerland.ORCID https://orcid.org/0000-0002-0647-9273
Olav JansenDepartment of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, University of Kiel, Kiel, Germany.
Angelika AlonsoDepartment of Neurology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.ORCID https://orcid.org/0000-0003-2487-7205
Christian LoehrDepartment of Radiology and Neuroradiology, Klinikum Vest, Recklinghausen, Germany.
David S LiebeskindDepartment of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, USA.
Jan GrallaDepartment of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, University of Bern, Bern, Switzerland.
Urs FischerDepartment of Neurology, University Hospital Bern Inselspital, University of Bern, Bern, Switzerland.
Johannes KaesmacherDepartment of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, University of Bern, Bern, Switzerland.
SWIFT DIRECT investigators

Funding

Medtronic Inc.
6 · The paper itself

Abstract

background and purposeThe value of intravenous thrombolysis (IVT) in eligible tandem lesion patients undergoing endovascular treatment (EVT) is unknown. We investigated treatment effect heterogeneity of EVT + IVT versus EVT-only in tandem lesion patients. Additional analyses were performed for patients undergoing emergent internal carotid artery (ICA) stenting.

methodsSWIFT DIRECT randomized IVT-eligible patients to either EVT + IVT or EVT-only. Primary outcome was 90-day functional independence (modified Rankin Scale score 0-2) after the index event. Secondary endpoints were reperfusion success, 24 h intracranial hemorrhage rate, and 90-day all-cause mortality. Interaction models were fitted for all predefined outcomes.

resultsAmong 408 included patients, 63 (15.4%) had a tandem lesion and 33 (52.4%) received IVT. In patients with tandem lesions, 20 had undergone emergent ICA stenting (EVT + IVT: 9/33, 27.3%; EVT: 11/30, 36.7%). Tandem lesion did not show treatment effect modification of IVT on rates of functional independence (tandem lesion EVT + IVT vs. EVT: 63.6% vs. 46.7%, non-tandem lesion EVT + IVT vs. EVT: 65.6% vs. 58.2%; p for interaction = 0.77). IVT also did not increase the risk of intracranial hemorrhage  among tandem lesion patients (tandem lesion EVT + IVT vs. EVT: 34.4% vs. 46.7%, non-tandem lesion EVT + IVT vs. EVT: 33.5% vs. 26.3%; p for interaction = 0.15). No heterogeneity was noted for other endpoints (p for interaction > 0.05).

conclusionsNo treatment effect heterogeneity of EVT + IVT versus EVT-only was observed among tandem lesion patients. Administering IVT in patients with anticipated emergent ICA stenting seems safe, and the latter should not be a factor to consider when deciding to administer IVT before EVT.

Indexed as

Endovascular ProceduresFibrinolytic AgentsStentsThrombectomyTissue Plasminogen ActivatorAdministration, IntravenousAgedAged, 80 and overCarotid StenosisFemaleHumansIschemic StrokeMaleMiddle AgedThrombolytic TherapyTreatment OutcomeFibrinolytic AgentsTissue Plasminogen Activatorextracranial stentintravenous thrombolysismechanical thrombectomyrandomized controlled trialtandem lesion

Identifiers

PMID38409874
PMCPMC11235868

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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.