Evidence map›Paper›PMID 42189238›Full record

ArticleJournal of neurology2026

RAPID-LC: rapid evidence-to-practice uptake of large core thrombectomy across a stroke consortium.

Osman Mir, Alzahra'a Al Matairi, Dan Nguyen, Amrou Sarraj, Adam A Dmytriw, Adnan H Siddiqui, Ramesh Grandhi, Jaydevsinh N Dolia, Diogo C Haussen, Alhamza R Al-Bayati and 38 more

Erratum issuedAbstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in Journal of neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–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

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

48 authors.

Osman MirBaylor University Medical Center, Dallas, USA.
Alzahra'a Al MatairiFaculty of Medicine, University of Jordan, Amman, Jordan.
Dan NguyenTexas Stroke Institute, Plano, USA.
Amrou SarrajCase Western Reserve University, Cleveland, USA.
Adam A DmytriwDepartment of Neuroradiology, Oxford University Hospitals NHS Foundation Trust, Oxfordshire, England.
Adnan H SiddiquiDepartment of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA.
Ramesh GrandhiUniversity of Utah, Salt Lake City, USA.
Jaydevsinh N DoliaEmory University School of Medicine, Atlanta, GA, USA.
Diogo C HaussenEmory University School of Medicine, Atlanta, GA, USA.
Alhamza R Al-BayatiDepartment of Neurology, UPMC Stroke Institute, Pittsburgh, USA.
Raul G NogueiraDepartment of Neurology, UPMC Stroke Institute, Pittsburgh, USA.
Brendan EbyDepartment of Neurology, Washington University School of Medicine, St. Louis, USA.
Ali AlarajDepartment of Neurosurgery, University of Illinois at Chicago, Chicago, USA.
Saif BushnaqDepartment of Neurology, Texas Tech University Health Sciences Center, Lubbock, USA.
Jan Karl BurkhardtUniversity of Pennsylvania, Philadelphia, USA.
Visish SrinivasanUniversity of Pennsylvania, Philadelphia, USA.
Hesham MasoudSUNY Upstate Medical University, Syracuse, USA.
Navdeep SanghaDepartment of Neurology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, USA.
Angus LeeDepartment of Neurology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, USA.
Yazan AshouriNeuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, USA.
Imran FarooquiHCA Houston Healthcare Clearlake, Webster, USA.
Yazan J AlderaziHCA Houston Healthcare Clearlake, Webster, USA.
Gerald OgolaBaylor University Medical Center, Dallas, USA.
Kartik AkkihalTexas A&M College of Medicine, Bryan, USA.
Abdelrahaman BeltagyTexas Stroke Institute, Plano, USA.
Kelsey R DuncanCase Western Reserve University, Cleveland, USA.
Yan-Lin LiDepartment of Neuroradiology, Oxford University Hospitals NHS Foundation Trust, Oxfordshire, England.
Lukasz PrzepiorkaDepartment of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA.
Omid ShorakaUniversity of Utah, Salt Lake City, USA.
Theja YelamEmory University School of Medicine, Atlanta, GA, USA.
Mohamed F DoheimDepartment of Neurology, UPMC Stroke Institute, Pittsburgh, USA.
Laura HeitschDepartment of Neurology, Washington University School of Medicine, St. Louis, USA.
Tatiana Abou-MradDepartment of Neurosurgery, University of Illinois at Chicago, Chicago, USA.
Pichatorn SuppakitjanusantDepartment of Neurology, Texas Tech University Health Sciences Center, Lubbock, USA.
Kyle ScottUniversity of Pennsylvania, Philadelphia, USA.
Momotaz BegumSUNY Upstate Medical University, Syracuse, USA.
Mohammad AlMajaliNeuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, USA.
Faisal Al-ShaibiCase Western Reserve University, Cleveland, USA.
Zheqing ZhangMedical Sciences Division, University of Oxford, Oxford, USA.
Prince Pekyi-BoatengUniversity of Utah, Salt Lake City, USA.
Mithilesh SidduEmory University School of Medicine, Atlanta, GA, USA.
Mohammad KhasawnehDepartment of Neurology, Washington University School of Medicine, St. Louis, USA.
Michael AdegokeDepartment of Neurosurgery, University of Illinois at Chicago, Chicago, USA.
Myriam VijilDepartment of Neurology, Texas Tech University Health Sciences Center, Lubbock, USA.
Habib AkouriUniversity of Pennsylvania, Philadelphia, USA.
Zuhair AliUniversity of Houston, HCA Houston Healthcare Kingwood, Houston, USA.
Osama ZaidatNeuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, USA.
Mohamad EzzeldinUniversity of Houston, HCA Houston Healthcare Kingwood, Houston, USA. Mohamadezzeldin@hotmail.com.ORCID http://orcid.org/0000-0001-7740-8774

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRecent landmark trials, including SELECT2, ANGEL-ASPECT, and RESCUE-Japan LIMIT, demonstrated the benefit of endovascular thrombectomy (EVT) in patients with large ischemic cores, primarily among those with ASPECTS 3-5, with limited representation of ASPECTS 0-2. However, real-world adoption across the full spectrum of low ASPECTS remains uncertain.

methodsWe conducted a retrospective, multicenter, before-and-after cohort study comparing the pre-publication (July-December 2021, n = 150) and post-publication (January-June 2024, n = 195) periods. Adults presenting within 24 h of large vessel occlusion stroke with large cores (ASPECTS ≤ 5 or CT core > 70 mL) were included. The primary outcome was EVT utilization (receipt of thrombectomy). Secondary outcomes were 30- and 90-day modified Rankin Scale (mRS) and mortality. Safety outcomes included symptomatic intracranial hemorrhage and procedural complications. Multivariable logistic regression identified independent predictors of receiving EVT, adjusting for clinical and imaging variables.

resultsA total of 345 patients were included (median age 70 years, 52% male). EVT utilization increased from 42% (63/150) in 2021 to 60.5% (118/195) in 2024. In multivariable analysis, the year 2024 was the strongest independent predictor of receiving EVT (adjusted OR 3.11; p < 0.001). ASPECTS score was the dominant imaging predictor of receiving EVT (adjusted OR 7.11 for ASPECTS 3-5 vs 0-2). EVT use in patients with ASPECTS 0-2 increased from 4.3 to 32.5%. Among treated cohorts, mortality increased non-significantly from 27 to 33.9% (p = 0.340). Functional outcomes at 30 and 90 days did not differ significantly between cohorts.

conclusionPublication of large core thrombectomy trials was associated with substantial increases in endovascular thrombectomy use in large-core stroke, including among patients with very low ASPECTS, with a non-significant increase in symptomatic intracranial hemorrhage and a decline in favorable functional outcomes. Clinician adherence to baseline severity considerations (ASPECTS, age, and premorbid function) appears appropriate. These findings demonstrate the safe and rapid translation of evidence into practice and highlight the importance of standardized implementation strategies to optimize patient outcomes.

Indexed as

Endovascular ProceduresIschemic StrokeStrokeThrombectomyAgedAged, 80 and overFemaleHumansMaleMiddle AgedRetrospective StudiesASPECTS scoreEndovascular thrombectomyImplementationLarge core infarctionOutcomesPractice patterns

Identifiers

PMID42189238

What OpenQuestion holds

Textmetadata
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.