Evidence map›Paper›PMID 41876897›Full record

ArticleNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology2026

Revascularization treatments within 4.5 h after onset in acute ischemic stroke with isolated extracranial artery occlusion.

Manuel Cappellari, Ettore Nicolini, Valentina Saia, Giovanni Pracucci, Ludovica Guido, Ilaria Casetta, Enrico Fainardi, Sandra Bracco, Rossana Tassi, Antonio Laiso and 61 more

Abstract readMulticenter Study
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Article in Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

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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

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

71 authors.

Manuel CappellariStroke Unit, DAI Di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy. manuel.cappellari@aovr.veneto.it.ORCID http://orcid.org/0000-0002-3534-3201
Ettore NicoliniEmergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.
Valentina SaiaNeurology and Stroke Unit, S. Corona Hospital, Pietra Ligure, Italy.
Giovanni PracucciDepartment of NEUROFARBA, Neuroscience Section, University of Florence, Florene, Italy.
Ludovica GuidoStroke Unit, DAI Di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy.
Ilaria CasettaNeurology Unit, University Hospital Arcispedale S. Anna, Ferrara, Italy.
Enrico FainardiDipartimento Di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università Degli Studi di Firenze, Ospedale Universitario Careggi, Firenze, Italy.
Sandra BraccoUO Neurointerventistica, Ospedale S. Maria Delle Scotte-University Hospital, Siena, Italy.
Rossana TassiStroke Unit, Ospedale S. Maria Delle Scotte-University Hospital, Siena, Italy.
Antonio LaisoNeurovascular Interventional Unit - Careggi University Hospital, Florence, Italy.
Patrizia NenciniStroke Unit, Azienda Ospedaliero Univarsitaria Careggi, Firenze, Italy.
Maria RuggieroInterventional Neuroradiology, Ospedale Bufalini-AUSL Romagna, Cesena, Italy.
Marco LongoniNeurology E Stroke Unit, Ospedale Bufalini-AUSL Romagna, Cesena, Italy.
Andrea SalettiAzienda Ospedaliero Universitaria di Ferrara-Neuroradiologia-Dipartimento di Radiologia, Ferrara, Italy.
Alessandro De VitoDipartimento Di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università Degli Studi di Firenze, Ospedale Universitario Careggi, Firenze, Italy.
Nicola CavasinNeuroradiology, Ospedale Dell'Angelo Mestre, Venezia, Italy.
Adriana CritelliNeurology and Stroke Unit, Ospedale Dell'Angelo Mestre, Venezia, Italy.
Roberto MenozziDipartimento ad Attività Integrata Interaziendale Diagnostico, Azienda Ospedaliero Universitaria, Parma, Italy.
Alessandro PezziniDipartimento Di Medicina E Chirurgia, Università Degli Studi Di Parma & Percorso Stroke Care, Dipartimento Di Emergenza-Urgenza, Azienda Ospedaliero Universitaria, Parma, Italy.
Mauro BerguiDipartimento Neuroscienze, Universitá di Torino, Torino, Italy.
Giovanni BoscoStroke Unit AOU Citta della Salute - Ospedale Molinette, Torino, Italy.
Alessio ComaiServizio Di Neuroradiologia, Ospedale Provinciale di Bolzano, Bolzano, Italy.
Enrica FranchiniNeurologia, Ospedale Provinciale di Bolzano, Bolzano, Italy.
Claudia Rolla BiglianiDepartment of Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
Tiziana Benzi MarkushiNeurology and Stroke Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
Emilio LozuponeDepartment of Neuroradiology, Vito Fazzi Hospital, Lecce, Italy.
Sabino D'AgostinoDepartment of Neurology, Vito Fazzi Hospital, Lecce, Italy.
Stefano ValloneNeuroradiologia, Ospedale Civile Di Baggiovara, AOU Modena, Modena, Italy.
Guido BigliardiNeurologia/Stroke Unit, Ospedale Civile Di Baggiovara, AOU Modena, Modena, Italy.
Andrea BoghiSC Radiologia E Neuroradiologia, Ospedale San Giovanni Bosco, Torino, Italy.
Andrea NaldiS.C. Neurologia 2, Ospedale San Giovanni Bosco, Torino, Italy.
Ivan GallesioNeuroradiology Unit AO "SS Antonio E Biagio E C. Arrigo", Alessandria, Italy.
Alessandro CanessaNeurology Unit AO "SS Antonio E Biagio E C. Arrigo", Alessandria, Italy.
Michele BesanaU.O Neuroradiologia, Dipartimento Di Neuroscienze, Presidio Ospedaliero di Cremona, ASST Cremona, Cremona, Italy.
Alessia GiossiU.O Neurologia, Presidio Ospedaliero di Cremona, ASST Cremona, Cremona, Italy.
Luigi SimonettiDepartment of Neuroradiology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy.
Andrea ZiniDepartment of Neurology and Stroke Center, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Maggiore Hospital, Bologna, Italy.
Valerio Da RosInterventional Radiology Unit, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy.
Giordano LacidognaUOSD Stroke Unit, Policlinico Tor Vergata, Roma, Italy.
Nicola BurdiNeuroradiology, SS. Annunziata Hospital, Taranto, Italy.
Angelica TinelliNeurology, SS. Annunziata Hospital, Taranto, Italy.
Sergio Lucio VinciNeuroradiology Unit - University Hospital "G. Martino", Messina, Italy.
Paolino La SpinaStroke Unit - Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
Mauro PlebaniInterventional Radiology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Francesco VallettaStroke Unit, DAI Di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy.
Manuela De MicheleEmergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.
Antonio CiacciarelliEmergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.
Andrea RomiSS Interventistica Neurovascolare Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Alessandra PersicoUOC Neurologia d'Urgenza e Stroke Unit, IRCCS C. Mondino, Pavia, Italy.
Guido Andrea LazzarottiDepartment of Neuroradiology, University Hospital of Pisa, Pisa, Italy.
Gaia MignaniCentre of Cerebrovascular Disorders, Unit of Neurology, University Hospital of Pisa, Pisa, Italy.
Marco PerriNeuroradiology Unit, Presidio Ospedaliero SS. Filippo E Nicola, Avezzano, Italy.
Federica De SantisUOC Neurologia E Stroke Unit, Presidio Ospedaliero SS. Filippo e Nicola Avezzano, Avezzano, Italy.
Antioco SannaSC Neuroradiologia Ospedale Santa Corona Pietra Ligure Asl 2 Sistema Sanitario Regione Liguria, Genoa, Italy.
Elena CocoNeurology and Stroke Unit, S. Corona Hospital, Pietra Ligure, Italy.
Gianluca GalvanoUOC Diagnostica Per Immagini, Radiologia Interventistica E Neuroradiologia, ARNAS Garibaldi, Catania, Italy.
Eleonora SaraccoUOC Neurologia, Arnas Garibaldi Catania, Catania, Italy.
Matteo AlbertiUO Neuroradiologia, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy.
Paolo InvernizziUO Neurologia, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy.
Massimiliano AllegrittiRadiologia Interventistica, Dipartimento di Diagnostica, Azienda Ospedaliera "S. Maria", Terni, Italy.
Stefano CaproniNeurologia E Stroke Unit, Dipartimento di Neuroscienze, Azienda Ospedaliera "S. Maria", Terni, Italy.
Luigi ChiumaruloUOS Neuroradiologia Interventistica AOU Consorziale Policlinico, Bari, Italy.
Marco PetruzzellisUOC Neurologia Universitaria E Stroke Unit "F. Puca" AOU Consorziale Policlinico, Bari, Italy.
Giuseppe CaritàNeuroradiology Unit, Ospedale S. Maria Della Misericordia, Rovigo, Italy.
Monia RussoNeurology Unit, Ospedale S. Maria Della Misericordia, Rovigo, Italy.
Edoardo PuglielliUOS Radiologia Interventistica, ASL Teramo, Teramo, Italy.
Alfonsina CasalenaUO Neurologia, ASL Teramo, Teramo, Italy.
Ahmed NiazDepartment of Clinical Neuroscience (N.A.) Karolinska Institutet, Stockholm, Sweden.
Salvatore MangiaficoIRCCS Neuromed, Pozzilli (IS), Interventional Neuroradiology at Tor Vergata University, Sapienza University and S. Andrea Hospital, Rome, Italy.
Danilo ToniEmergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.
IRETAS, the SITS

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionThe optimal revascularization treatment in patients with acute ischemic stroke (AIS) and isolated extracranial artery occlusion remains uncertain. We aimed to compare outcomes between endovascular treatment (EVT) and intravenous thrombolysis (IVT) alone in patients with AIS and isolated extracranial artery occlusion without concomitant ipsilateral large intracranial occlusion treated ≤ 4.5 h of onset.

methodsWe retrospectively analyzed prospectively collected data from two multicenter registries (IRETAS for EVT and SITS-ISTR for IVT). Primary efficacy endpoints were 3-month modified Rankin Scale (mRS) score 0–1 and 0–2. Primary safety endpoints were symptomatic intracranial hemorrhage (sICH) and 3-month mortality. Multivariable logistic regression was used to adjust for imbalances in demographics, clinical variables, stroke etiology data, and procedure data.

resultsA total of 793 patients were included in the study (EVT, n = 358; IVT alone, n = 389; control angiography, n = 46), of whom 633 with extracranial internal carotid artery (ICA) occlusion and 160 with extracranial vertebral artery (VA) occlusion. In the isolated extracranial ICA or VA occlusions, EVT was associated with lower rates of mRS 0–1 (aOR: 0.45, 95% CI: 0.29–0.71) and mRS 0–2 (aOR: 0.42, 95% CI: 0.27–0.66), higher rate of mortality (aOR: 2.91, 95% CI: 1.62–5.24). In the isolated extracranial ICA occlusion, IVT was associated with higher rates of mRS 0–2 (aOR: 2.63, 95% CI: 1.13–6.08) compared with control angiography.

conclusionsOur data support IVT ≤ 4.5 h after onset as first-line therapy in eligible patients with AIS and isolated extracranial artery occlusion whereas the benefit of EVT appears limited and warrants further investigation in RCTs.

Indexed as

Arterial Occlusive DiseasesCerebral RevascularizationEndovascular ProceduresIschemic StrokeThrombolytic TherapyAgedAged, 80 and overFemaleFibrinolytic AgentsHumansMaleMiddle AgedRegistriesRetrospective StudiesTime FactorsTreatment OutcomeFibrinolytic AgentsEndovascular treatmentInternal carotid arteryIsolated extracranial artery occlusionThrombectomyThrombolysisVertebral artery

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PMID41876897

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