ArticleNeuroepidemiology2026
Beyond the Parallel-Group Randomised Trial: A Portfolio of Designs for Cerebrovascular Neurosurgery.
Article in Neuroepidemiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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.
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.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe randomised parallel-group trial is the dominant evaluation instrument in evidence-based medicine, yet several cerebrovascular diseases violate most of the assumptions on which it depends. Unruptured arteriovenous malformations, unruptured intracranial aneurysms, asymptomatic carotid stenosis, and symptomatic haemodynamic carotid or middle cerebral artery occlusion are rare; their natural histories extend across decades; their treatments concentrate substantial harm at a single moment; outcomes depend on operator skill and infrastructure; and the choice between operating and waiting often turns on patient values. The resulting evidence base is sparse, is inconsistent, and rarely changes practice.
methodsThis evidentiary deficit cannot be resolved by performing more conventional trials but by widening the portfolio of designs. After characterising the structural features that make the parallel-group trial inadequate here, we describe five proposals: expertise-based cohort-embedded randomisation, plaque-progression-enriched randomisation, a Bayesian sequential three-arm trial, a stepped-wedge cluster trial, and a synthesising, aspirational multi-arm Bayesian platform that shares a continuously updated natural-history control across strata. For each proposal, we set out the eligibility logic, the analytic engine, and the operational obstacles and verify illustrative sample-size assumptions by Monte Carlo simulation where applicable.
conclusionCerebrovascular disease requires a wider design vocabulary than the parallel-group RCT. Expertise-based randomisation, cohort embedding, adaptive enrichment, Bayesian inference, stepped-wedge allocation, and platform trials are established tools that address rarity, operator heterogeneity, long latency, and patient preference directly. Deploying them in cerebrovascular neuroepidemiology is achievable but will require registry infrastructure, sustained multi-cycle funding, and governance arrangements that do not yet exist in most settings.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
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.