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id="_NBK577865_"><span itemprop="name">Evidence review for thrombectomy</span></h1><div class="subtitle">Stroke and transient ischaemic attack in over 16s: diagnosis and initial management</div><p><b>Evidence review D</b></p><p><i>NICE Guideline, No. 128</i></p><p class="contrib-group"><h4>Authors</h4><span itemprop="author">National Guideline Centre (UK)</span>.</p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2019 May</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-3386-0</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2019.</div></div><div class="bkr_clear"></div></div><div id="ch4.s1"><h2 id="_ch4_s1_">1. Endovascular therapy</h2><div id="ch4.s1.1"><h3>1.1. Review question: What is the clinical and cost effectiveness of endovascular therapy (EVT) with or without intravenous thrombolysis versus intravenous thrombolysis to improve outcomes?</h3></div><div id="ch4.s1.2"><h3>1.2. Introduction</h3><p>Ischaemic stroke secondary to occlusion of a proximal intracerebral artery is a major and rising source of morbidity and mortality in the UK. Intravenous thrombolytic therapy has formed the mainstay of acute treatment over the last twenty years but increasingly there has been interest in alternative means of vessel recanalisation using neurointerventional endovascular techniques in order to achieve more effective brain reperfusion in an attempt to minimise the damage caused by an occluded artery. Initial evidence provided by randomised trials published in 2013 suggested that endovascular therapy offered no conclusive benefit to patients over standard medical therapy but these trials were criticised for speed of recruitment, use of out-dated technology and mode of patient selection. Since 2015 there have been numerous publications describing a large number of multi-centre randomised controlled trials that have investigated the use of more contemporary neurointerventional techniques. We aim to assess this evidence for the use of endovascular thrombectomy in acute stroke patients suffering a proximal intracerebral arterial occlusion.</p></div><div id="ch4.s1.3"><h3>1.3. PICO table</h3><p>For full details see the review protocol in <a href="#ch4.appa">appendix A</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch4tab1"><a href="/books/NBK577865/table/ch4.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figch4tab1" rid-ob="figobch4tab1"><img class="small-thumb" src="/books/NBK577865/table/ch4.tab1/?report=thumb" src-large="/books/NBK577865/table/ch4.tab1/?report=previmg" alt="Table 1. PICO characteristics of review question." /></a><div class="icnblk_cntnt"><h4 id="ch4.tab1"><a href="/books/NBK577865/table/ch4.tab1/?report=objectonly" target="object" rid-ob="figobch4tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">PICO characteristics of review question. </p></div></div></div><div id="ch4.s1.4"><h3>1.4. Methods and process</h3><p>This evidence review was developed using the methods and process described in Developing NICE guidelines: the manual.<a class="bibr" href="#ch4.ref23" rid="ch4.ref23"><sup>23</sup></a> Methods specific to this review question are described in the review protocol in <a href="#ch4.appa">appendix A</a>.</p><p>Declarations of interest were recorded according to NICE’s 2014 conflicts of interest policy upto March 2018, and NICE’s 2018 conflicts of interest policy from April 2018.</p></div><div id="ch4.s1.5"><h3>1.5. Clinical evidence</h3><div id="ch4.s1.5.1"><h4>1.5.1. Included studies</h4><p>Ten studies detailed in 15 papers were included in the review;<a class="bibr" href="#ch4.ref6" rid="ch4.ref6"><sup>6</sup></a><sup>,</sup>
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<a class="bibr" href="#ch4.ref7" rid="ch4.ref7"><sup>7</sup></a><sup>,</sup>
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<a class="bibr" href="#ch4.ref15" rid="ch4.ref15"><sup>15</sup></a><sup>,</sup>
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<a class="bibr" href="#ch4.ref17" rid="ch4.ref17"><sup>17</sup></a><sup>,</sup>
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<a class="bibr" href="#ch4.ref21" rid="ch4.ref21"><sup>21</sup></a><sup>,</sup>
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<a class="bibr" href="#ch4.ref28" rid="ch4.ref28"><sup>28</sup></a><sup>,</sup>
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<a class="bibr" href="#ch4.ref30" rid="ch4.ref30"><sup>30</sup></a><sup>,</sup>
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<a class="bibr" href="#ch4.ref37" rid="ch4.ref37"><sup>37</sup></a><sup>,</sup>
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<a class="bibr" href="#ch4.ref42" rid="ch4.ref42"><sup>42</sup></a><sup>,</sup>
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<a class="bibr" href="#ch4.ref51" rid="ch4.ref51"><sup>51</sup></a><sup>,</sup>
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<a class="bibr" href="#ch4.ref66" rid="ch4.ref66"><sup>66</sup></a><sup>,</sup>
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<a class="bibr" href="#ch4.ref71" rid="ch4.ref71"><sup>71</sup></a><sup>,</sup>
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<a class="bibr" href="#ch4.ref76" rid="ch4.ref76"><sup>76</sup></a><sup>,</sup>
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<a class="bibr" href="#ch4.ref90" rid="ch4.ref90"><sup>90</sup></a><sup>,</sup>
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<a class="bibr" href="#ch4.ref91" rid="ch4.ref91"><sup>91</sup></a> these are summarised in <a class="figpopup" href="/books/NBK577865/table/ch4.tab2/?report=objectonly" target="object" rid-figpopup="figch4tab2" rid-ob="figobch4tab2">Table 2</a> below and compare endovascular therapy (thrombectomy) with or without thrombolysis (alteplase) versus usual care (with or without thrombolysis). All of the RCT evidence found was based on anterior circulation stroke. Evidence from these studies is summarised in the clinical evidence summary below (<a class="figpopup" href="/books/NBK577865/table/ch4.tab2/?report=objectonly" target="object" rid-figpopup="figch4tab2" rid-ob="figobch4tab2">Table 2</a>). See also the study selection flow chart in <a href="#ch4.appc">appendix C</a>, forest plots in <a href="#ch4.appe">appendix E</a>, study evidence tables in <a href="#ch4.appd">appendix D</a>, GRADE tables in <a href="#ch4.appf">appendix F</a> and excluded studies list in <a href="#ch4.apph">appendix H</a>.</p><p>As no RCT study data was found for posterior circulatory stroke, an additional observational study search was carried out for this stratum. No studies met the inclusion criteria.</p><div id="ch4.s1.5.1.1"><h5>1.5.1.1. Anterior circulation stroke</h5><p>All the studies followed the PROBE design (prospective, randomized, open-label, controlled trial with blinded outcome evaluation). It is noted that although this is the highest quality of study design suitable for these trials, subjective outcomes (EQ-5D and mRS) have been downgraded due to lack of blinding of the interventions for the patient or care giver. All the trials were in people aged 18 and over, but this was considered similar enough to our protocol of 16 years and over not to warrant a downgrade in evidence quality. The majority of studies were funded by industry.</p><p>Following the results of MR CLEAN<a class="bibr" href="#ch4.ref15" rid="ch4.ref15"><sup>15</sup></a> which showed efficacy of thrombectomy, the majority of other trials stopped recruitment. Some conducted planned interim analysis; others state that they are underpowered.</p><p>A pre-planned subgroup analysis based on time to thrombectomy was performed due to heterogeneity. This resolved the inconsistency and so the results are reported according to the pre-specified subgroups based on time to thrombectomy. The DAWN<a class="bibr" href="#ch4.ref76" rid="ch4.ref76"><sup>76</sup></a> trial investigated thrombectomy performed 6 - 24 hours after a stroke and the DEFUSE 3 trial had time to treatment of 6 - 16 hours after symptom onset and has also been included in the 6 - 24 hour subgroup. The REVASCAT<a class="bibr" href="#ch4.ref51" rid="ch4.ref51"><sup>51</sup></a> and ESCAPE<a class="bibr" href="#ch4.ref42" rid="ch4.ref42"><sup>42</sup></a> trials have been reported individually as thrombectomy was performed within 8 and 12 hours respectively. The remaining studies all performed thrombectomy within 6 hours and have been meta-analysed.</p></div></div><div id="ch4.s1.5.2"><h4>1.5.2. Posterior circulation stroke</h4><p>No RCT or observational data were found for this stratum that met the protocol criteria. It is noted that the BEST<a class="bibr" href="#ch4.ref60" rid="ch4.ref60"><sup>60</sup></a> trial, a multicentre randomised outcome blinded trial on acute ischaemic stroke due to basilar artery occlusion, has a published protocol. The trial was due to have finished in March 2018 but no results have yet been published and therefore this trial is not included in the review. The trial authors were contacted for further information but no response was received.</p></div><div id="ch4.s1.5.3"><h4>1.5.3. Excluded studies</h4><div id="ch4.s1.5.3.1"><h5>1.5.3.1. Anterior circulation stroke</h5><p>EASI,<a class="bibr" href="#ch4.ref53" rid="ch4.ref53"><sup>53</sup></a> and IMS III<sup>1</sup> were excluded as imaging was not conducted as standard prior to inclusion in study (therefore they do not meet the protocol criterion of having a proven large vessel occlusion on non-invasive angiography).</p></div><div id="ch4.s1.5.3.2"><h5>1.5.3.2. Posterior circulation stroke</h5><p>Observational studies were excluded primarily for being non-comparative, having the wrong interventions or having a mixed stroke population with no separate analysis for the posterior circulation.</p><p>See the excluded studies list in <a href="#ch4.apph">appendix H</a>.</p></div></div><div id="ch4.s1.5.4"><h4>1.5.4. Summary of clinical studies included in the evidence review</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch4tab2"><a href="/books/NBK577865/table/ch4.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figch4tab2" rid-ob="figobch4tab2"><img class="small-thumb" src="/books/NBK577865/table/ch4.tab2/?report=thumb" src-large="/books/NBK577865/table/ch4.tab2/?report=previmg" alt="Table 2. Summary of studies included in the evidence review for anterior circulation stroke." /></a><div class="icnblk_cntnt"><h4 id="ch4.tab2"><a href="/books/NBK577865/table/ch4.tab2/?report=objectonly" target="object" rid-ob="figobch4tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of studies included in the evidence review for anterior circulation stroke. </p></div></div><p>See <a href="#ch4.appd">appendix D</a> for full evidence tables.</p></div><div id="ch4.s1.5.5"><h4>1.5.5. Quality assessment of clinical studies included in the evidence review</h4><div id="ch4.s1.5.5.1"><h5>1.5.5.1. Anterior circulation stroke</h5><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch4tab3"><a href="/books/NBK577865/table/ch4.tab3/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img figpopup" rid-figpopup="figch4tab3" rid-ob="figobch4tab3"><img class="small-thumb" src="/books/NBK577865/table/ch4.tab3/?report=thumb" src-large="/books/NBK577865/table/ch4.tab3/?report=previmg" alt="Table 3. Clinical evidence summary: thrombectomy within 6 hours with or without alteplase versus alteplase or standard medical care." /></a><div class="icnblk_cntnt"><h4 id="ch4.tab3"><a href="/books/NBK577865/table/ch4.tab3/?report=objectonly" target="object" rid-ob="figobch4tab3">Table 3</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: thrombectomy within 6 hours with or without alteplase versus alteplase or standard medical care. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch4tab4"><a href="/books/NBK577865/table/ch4.tab4/?report=objectonly" target="object" title="Table 4" class="img_link icnblk_img figpopup" rid-figpopup="figch4tab4" rid-ob="figobch4tab4"><img class="small-thumb" src="/books/NBK577865/table/ch4.tab4/?report=thumb" src-large="/books/NBK577865/table/ch4.tab4/?report=previmg" alt="Table 4. Clinical evidence summary: thrombectomy within 8 hours with or without alteplase versus alteplase or standard medical care." /></a><div class="icnblk_cntnt"><h4 id="ch4.tab4"><a href="/books/NBK577865/table/ch4.tab4/?report=objectonly" target="object" rid-ob="figobch4tab4">Table 4</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: thrombectomy within 8 hours with or without alteplase versus alteplase or standard medical care. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch4tab5"><a href="/books/NBK577865/table/ch4.tab5/?report=objectonly" target="object" title="Table 5" class="img_link icnblk_img figpopup" rid-figpopup="figch4tab5" rid-ob="figobch4tab5"><img class="small-thumb" src="/books/NBK577865/table/ch4.tab5/?report=thumb" src-large="/books/NBK577865/table/ch4.tab5/?report=previmg" alt="Table 5. Clinical evidence summary: thrombectomy within 12 hours with or without alteplase versus alteplase or standard medical care." /></a><div class="icnblk_cntnt"><h4 id="ch4.tab5"><a href="/books/NBK577865/table/ch4.tab5/?report=objectonly" target="object" rid-ob="figobch4tab5">Table 5</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: thrombectomy within 12 hours with or without alteplase versus alteplase or standard medical care. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch4tab6"><a href="/books/NBK577865/table/ch4.tab6/?report=objectonly" target="object" title="Table 6" class="img_link icnblk_img figpopup" rid-figpopup="figch4tab6" rid-ob="figobch4tab6"><img class="small-thumb" src="/books/NBK577865/table/ch4.tab6/?report=thumb" src-large="/books/NBK577865/table/ch4.tab6/?report=previmg" alt="Table 6. Clinical evidence summary: thrombectomy between 6 - 24 hours onset of symptoms versus standard medical care." /></a><div class="icnblk_cntnt"><h4 id="ch4.tab6"><a href="/books/NBK577865/table/ch4.tab6/?report=objectonly" target="object" rid-ob="figobch4tab6">Table 6</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: thrombectomy between 6 - 24 hours onset of symptoms versus standard medical care. </p></div></div><p>See <a href="#ch4.appf">appendix F</a> for full GRADE tables.</p></div><div id="ch4.s1.5.5.2"><h5>1.5.5.2. Posterior circulation stroke</h5><p>No studies were identified.</p></div></div></div><div id="ch4.s1.6"><h3>1.6. Economic evidence</h3><div id="ch4.s1.6.1"><h4>1.6.1. Included studies</h4><p>Two published health economic studies with the relevant comparison in the population of people presenting within 0-6 hours of onset of ischaemic stroke were included in this review.<a class="bibr" href="#ch4.ref38" rid="ch4.ref38"><sup>38</sup></a><a class="bibr" href="#ch4.ref61" rid="ch4.ref61"><sup>61</sup></a> One of the published economic studies was adapted by the authors for the population of people presenting within 6-24 hours of onset of ischaemic stroke and this health economic study was also included in this review.<a class="bibr" href="#ch4.ref84" rid="ch4.ref84"><sup>84</sup></a> These studies are summarised in the health economic evidence profile below (<a class="figpopup" href="/books/NBK577865/table/ch4.tab7/?report=objectonly" target="object" rid-figpopup="figch4tab7" rid-ob="figobch4tab7">Table 7</a>) and the health economic evidence table in <a href="#ch4.appi">appendix I</a>.</p></div><div id="ch4.s1.6.2"><h4>1.6.2. Excluded studies</h4><p>Twelve economic studies relating to this review question were identified but were selectively excluded due to the availability of more applicable evidence of a greater methodological quality.<a class="bibr" href="#ch4.ref2" rid="ch4.ref2"><sup>2</sup></a><sup>,</sup>
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<a class="bibr" href="#ch4.ref10" rid="ch4.ref10"><sup>10</sup></a><sup>,</sup>
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<a class="bibr" href="#ch4.ref16" rid="ch4.ref16"><sup>16</sup></a><sup>,</sup>
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<a class="bibr" href="#ch4.ref29" rid="ch4.ref29"><sup>29</sup></a><sup>,</sup>
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<a class="bibr" href="#ch4.ref46" rid="ch4.ref46"><sup>46</sup></a><sup>,</sup>
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<a class="bibr" href="#ch4.ref50" rid="ch4.ref50"><sup>50</sup></a><sup>,</sup>
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<a class="bibr" href="#ch4.ref104" rid="ch4.ref104"><sup>104</sup></a><sup>,</sup>
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<a class="bibr" href="#ch4.ref113" rid="ch4.ref113"><sup>113</sup></a>
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<a class="bibr" href="#ch4.ref107" rid="ch4.ref107"><sup>107</sup></a>
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<a class="bibr" href="#ch4.ref22" rid="ch4.ref22"><sup>22</sup></a>
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<a class="bibr" href="#ch4.ref88" rid="ch4.ref88"><sup>88</sup></a>
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<a class="bibr" href="#ch4.ref11" rid="ch4.ref11"><sup>11</sup></a> These are listed in <a href="#ch4.apph">appendix H</a>, with reasons for exclusion given.</p><p>See also the health economic study selection flow chart in <a href="#ch4.appg">appendix G</a>.</p></div><div id="ch4.s1.6.3"><h4>1.6.3. Summary of studies included in the economic evidence review</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch4tab7"><a href="/books/NBK577865/table/ch4.tab7/?report=objectonly" target="object" title="Table 7" class="img_link icnblk_img figpopup" rid-figpopup="figch4tab7" rid-ob="figobch4tab7"><img class="small-thumb" src="/books/NBK577865/table/ch4.tab7/?report=thumb" src-large="/books/NBK577865/table/ch4.tab7/?report=previmg" alt="Table 7. Health economic evidence profile: intravenous tissue-type plasminogen activator and endovascular therapy versus intravenous tissue-type plasminogen activator alone." /></a><div class="icnblk_cntnt"><h4 id="ch4.tab7"><a href="/books/NBK577865/table/ch4.tab7/?report=objectonly" target="object" rid-ob="figobch4tab7">Table 7</a></h4><p class="float-caption no_bottom_margin">Health economic evidence profile: intravenous tissue-type plasminogen activator and endovascular therapy versus intravenous tissue-type plasminogen activator alone. </p></div></div></div><div id="ch4.s1.6.4"><h4>1.6.4. Unit costs</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch4tab8"><a href="/books/NBK577865/table/ch4.tab8/?report=objectonly" target="object" title="Table 8" class="img_link icnblk_img figpopup" rid-figpopup="figch4tab8" rid-ob="figobch4tab8"><img class="small-thumb" src="/books/NBK577865/table/ch4.tab8/?report=thumb" src-large="/books/NBK577865/table/ch4.tab8/?report=previmg" alt="Table 8. UK costs of endovascular therapy, perfusion imaging and intravenous tissue-type plasminogen activator and endovascular therapy." /></a><div class="icnblk_cntnt"><h4 id="ch4.tab8"><a href="/books/NBK577865/table/ch4.tab8/?report=objectonly" target="object" rid-ob="figobch4tab8">Table 8</a></h4><p class="float-caption no_bottom_margin">UK costs of endovascular therapy, perfusion imaging and intravenous tissue-type plasminogen activator and endovascular therapy. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch4tab9"><a href="/books/NBK577865/table/ch4.tab9/?report=objectonly" target="object" title="Table 9" class="img_link icnblk_img figpopup" rid-figpopup="figch4tab9" rid-ob="figobch4tab9"><img class="small-thumb" src="/books/NBK577865/table/ch4.tab9/?report=thumb" src-large="/books/NBK577865/table/ch4.tab9/?report=previmg" alt="Table 9. UK costs of intravenous tissue-type plasminogen activator." /></a><div class="icnblk_cntnt"><h4 id="ch4.tab9"><a href="/books/NBK577865/table/ch4.tab9/?report=objectonly" target="object" rid-ob="figobch4tab9">Table 9</a></h4><p class="float-caption no_bottom_margin">UK costs of intravenous tissue-type plasminogen activator. </p></div></div></div></div><div id="ch4.s1.7"><h3>1.7. Resource costs</h3><p>The recommendations made in this review that thrombectomy is offered are likely to have a substantial impact on resources for the NHS in England.</p><p>Additional costs are likely to be incurred for the following reasons: the population eligible for thrombectomy will be increased; more people with stroke will need to be transferred to centres offering thrombectomy, and additional training will be required. Further work is being carried out to quantify the potential resource impact in this area.</p><p>The committee also made a recommendation based on this review (see section <b>Error! R eference source not found.</b>: <b>Error! Reference source not found.</b>) that thrombectomy should be ‘considered’ for people with acute ischaemic stroke last known to be well up to 24 hours previously (including wake up strokes) with confirmed occlusion of the proximal posterior circulation and with potentially salvageable brain tissue. Unlike for stronger recommendations stating that interventions should be adopted, it is not possible to make a judgement about the potential resource impact to the NHS of recommendations regarding interventions that could be used, as uptake is too difficult to predict. However, the committee noted that this is already current best practice.</p></div><div id="ch4.s1.8"><h3>1.8. Evidence statements</h3><div id="ch4.s1.8.1"><h4>1.8.1. Clinical evidence statements</h4><div id="ch4.s1.8.1.1"><h5>1.8.1.1. Anterior circulation stroke</h5><ul id="l93"><li id="lt264" class="half_rhythm"><div>Six trials in 1334 people were included investigating the use of mechanical thrombectomy with or without thrombolysis, within 6 hours after the onset of symptoms of acute ischaemic stroke, compared to thrombolysis or usual care with follow up at 90 days. Thrombectomy showed a clinical benefit compared to control for functional independence, measured by mRS (increase in those with a score of 0–2; Moderate quality). No clinical difference in mortality, serious adverse events or quality of life was reported (Moderate quality). It is uncertain if there are any differences in symptomatic and non-symptomatic intracerebral haemorrhage outcomes due to low event rates (Low quality).</div></li><li id="lt265" class="half_rhythm"><div>One trial in 206 people receiving thrombectomy within 8 hours, with or without thrombolysis, compared to usual care showed a benefit of thrombectomy for functional independence (Low quality) and for quality of life measured by EQ-5D (Moderate quality). This trial also reported an uncertain impact on mortality rates, symptomatic intra-cranial haemorrhage and recurrent stroke (Low quality).</div></li><li id="lt266" class="half_rhythm"><div>One trial in 316 people receiving thrombectomy, with or without thrombolysis, within 12 hours compared to control, again showed a clinical benefit of thrombectomy for functional independence and mortality (Moderate quality). The study also reported a clinical benefit of thrombectomy for reduced incidence of malignant middle cerebral syndrome compared to control (High quality) and for improved quality of life (EQ-5D visual analogue scale) at 90 days (Moderate quality) and an uncertain impact on symptomatic intracerebral haemorrhage (Low quality).</div></li><li id="lt267" class="half_rhythm"><div>Two studies in 388 people investigated thrombectomy, with or without thrombolysis, after 6 hours, but within 24 hours of symptom onset in acute ischaemic stroke. These studies showed a clinical benefit of thrombectomy for functional outcome and mortality at 90 days follow up (Very Low to Moderate quality) and no clinical difference in symptomatic intracerebral haemorrhage (Low quality). Procedural complications were reported as a harm of thrombectomy (High quality).</div></li></ul></div><div id="ch4.s1.8.1.2"><h5>1.8.1.2. Posterior circulation stroke</h5><p>No studies were identified for this stratum.</p></div></div><div id="ch4.s1.8.2"><h4>1.8.2. Health economic evidence statements</h4><ul id="l93a"><li id="lt268" class="half_rhythm"><div>One cost-utility analysis found that IV t-PA and mechanical thrombectomy was cost effective compared with IV t-PA alone for treating acute ischaemic stroke, within 0-6 hours of stroke onset. (ICER: £7,648 per QALY gained). This analysis was assessed as directly applicable with minor limitations.</div></li><li id="lt269" class="half_rhythm"><div>One cost-utility analysis found that IV t-PA and mechanical thrombectomy was dominant over IV t-PA alone for treating acute ischaemic stroke, within 0-6 hours of stroke onset. This analysis was assessed as directly applicable with minor limitations.</div></li><li id="lt270" class="half_rhythm"><div>One cost-utility analysis found that mechanical thrombectomy following best medical therapy was cost effective compared with medical therapy alone for treating acute ischaemic stroke, 6-24 hours after stroke onset. This analysis was assessed as directly applicable with minor limitations.</div></li></ul></div></div><div id="ch4.s1.9"><h3>1.9. The committee’s discussion of the evidence</h3><div id="ch4.s1.9.1"><h4>1.9.1. Interpreting the evidence</h4><div id="ch4.s1.9.1.1"><h5>1.9.1.1. The outcomes that matter most</h5><p>The critical outcomes identified for this review were functional outcome (modified Rankin Scale) and mortality at 90 days and 1 year. The committee considered both outcomes to be vital in decision making. Important outcomes included intracerebral haemorrhage, procedural complications and quality of life (EQ-5D). Patient reported outcome measures were also considered, but no evidence was identified.</p></div><div id="ch4.s1.9.1.2"><h5>1.9.1.2. The quality of the evidence</h5><p>Ten RCTs detailed in 15 papers were included in the review. The studies included people with large vessel occlusion demonstrated by CT or MRI. All were in the anterior circulation population. No randomised trials were found for the posterior circulation stroke population so observational studies were sought, but none that met the inclusion criteria were identified. The trials were all prospective randomised open blinded end-point (PROBE) trials. This meant that patients and care givers were not blinded to the intervention, but the outcome assessors were. Subjective outcomes (mRS and quality of life) were therefore downgraded for risk of bias. Some outcomes, including symptomatic intracerebral haemorrhage and recurrent stroke, had very few events and therefore had estimates of effect with wide confidence intervals and were downgraded for imprecision.</p><p>A subgroup analysis of timing of thrombectomy was performed for all outcomes. The studies were grouped into those performing thrombectomy within 6 hours, up to 8 hours, up to 12 hours and those conducted at any time more than 6 hours and up to 24 hours after the onset of stroke.</p><p>The majority of studies were funded by industry, but the committee considered that the evidence should not be downgraded for publication bias and that the study design ensured robustness of evidence. It was noted that following the results of MR CLEAN,<a class="bibr" href="#ch4.ref15" rid="ch4.ref15"><sup>15</sup></a> which showed efficacy of thrombectomy, the majority of other trials stopped recruitment early due to superior efficacy of thrombectomy. Some conducted planned interim analysis; others state that they are underpowered. Although the committee recognised the potential for an overestimation of treatment effect in the trials that were stopped early, evidence was not downgraded because of this.</p><p>Evidence ranged from very low to high quality, with the majority of the evidence rated as moderate quality.</p><p>Three cost utility analyses from the UK NHS perspective were included in the health economic review and were assessed as directly applicable with minor limitations.</p></div><div id="ch4.s1.9.1.3"><h5>1.9.1.3. Benefits and harms Anterior circulation stroke</h5><p>The evidence showed a clear clinical benefit for functional outcome (higher functional independence; mRS score of 0–2 and by ordinal shift analysis) compared to usual care, which was IV thrombolysis in the majority of studies, when thrombectomy was performed within 6, 8, or 12 hours. IV thrombolysis was administered in both the thrombectomy and usual care groups in the majority of patients. This benefit was even seen in studies recruiting between 6 and 24 hours of stroke onset, when few patients in either the thrombectomy or usual care group received thrombolyisis as this is outside the licenced time window, with either no clinical difference or a clinical benefit of thrombectomy for mortality. The committee discussed the evidence from the study of thrombectomy within 8 hours, which had a direction of effect suggesting a possible harm of thrombectomy from increased mortality. This was not consistent with the other trials or the mortality outcome at 12 months from the same trial, where the direction of effect favoured thrombectomy. The committee agreed that this small absolute difference from a single trial with imprecision around the estimate was not convincing enough to indicate a true clinical harm of thrombectomy, but may reflect a small increase in intracerebral haemorrhages seen in this trial among those receiving thrombectomy.</p><p>The majority of people also received IV alteplase across both arms of the studies, as part of best medical practice. The committee noted that people receiving thrombectomy between 6 and 24 hours after stroke onset were outside of usual eligibility criteria and treatment with alteplase is less likely in this group as it is indicated for use within 4.5 hours of symptom onset. The committee discussed the studies that included people up to 8 and 12 hours after onset, noting that the majority of participants recived IV alteplase, which was likely to reflect the proportion who were included within the licenced time window for IV thrombolysis. As a minority of patients in the studies including those who had thrombectomy 6-24 hours after stroke onset received IV thrombolysis and a benefit of thrombectomy alone was still seen, the committee agreed that, in line with the licencing criteria, those presenting during this later time window should not routinely be offered IV thrombolysis.</p><p>There was also specific evidence from a trial that included people with the procedure performed up to 12 hours after stroke onset, that thrombectomy was associated with fewer cases of malignant middle cerebral artery syndrome at 90 days. No evidence was identified for this outcome for thrombectomy performed within other time frames.</p><p>The committee discussed the findings for the adverse event symptomatic intracerebral haemorrhage. For thrombectomy plus thrombolysis within 6 hours there was no clinical difference for this outcome. For the later time points there were fewer cases of symptomatic intracerebral haemorrhage in the standard care group; however, the number of events was small and the effect estimates were imprecise. Since this potential harm was not reflected in the primary outcome measures and there was uncertainty in the true effect, the committee did not believe this to be a clinically important difference.</p><p>Quality of life (EQ-5D) was reported across several studies and showed either no difference or a benefit of thrombectomy with or without thrombolysis within 6, 8 and 12 hours, compared to control at 90 days. No data were available for this outcome from the 2 studies reporting on thrombectomy performed between 6 and 24 hours after stroke onset.</p><p>Some procedural complications associated with thrombectomy were noted, but were considered to be outweighed by the benefits of functional outcome improvement. Other studies reported on serious adverse events and recurrent stroke at 90 days and showed no clear clinical difference between treatment arms.</p><p>Overall there is strong evidence for a clinical benefit of thrombectomy, together with intravenous thrombolyisis if within the licenced time window, for improving functional outcome when performed in people last known to be well up to 24 hours previously, with no clinical difference in mortality rates. Therefore, the committee made strong recommendations for thrombectomy up to 24 hours after stroke onset (that is, from when a person was last known to be well) in people with appropriate clinical and radiological characteristics. The committee agreed that it was important to specify that this should be done in people who present with an acute ischaemic stroke syndrome as it is possible to have an occlusion without stroke symptoms and intervention should not currently be attempted in these people. It is also important that the occlusion is confirmed by CTA or MRA if performed within 6 hours and CT perfusion or MRI DWI sequences if performed beyond 6 hours in order to identify a target for reperfusion with thrombectomy.</p><p>The committee discussed their experience that the plain CT scan may be assessed using the Alberta Stroke Program Early CT Score (ASPECTS), with a score of more than 6 indicating a good volume of salvageable brain tissue. They noted that in the presence of a low ASPECTS score, imaging with CT perfusion or MRI could be considered within an earlier timeframe. Even within 6 hours of stroke onset it is possible for there to be a malignant core of severe, established ischaemic change that cannot be salvaged as collaterals have already failed; in such cases there is no potential for benefit of intervention and the procedure could cause harm and so would not be indicated. When thrombectomy is undertaken between 6 and 24 hours after stroke onset, potential benefit must be demonstrated by further appropriate imaging with CT or MRI because the evidence of effectiveness from the trials was based on more highly selected populations using CT perfusion and MRI diffusion and perfusion scans and effectiveness in a broader population is likely to be lower. In terms of clinical characteristics, it is important to consider the NIHSS score and overall functional capacity prior to the stroke to determine suitability for this intervention. Most studies used an entry criteria of a pre morbid Rankin (mRS) <2 for thrombectomy. There was a range of NIHSS severity scores across the trials ranging from no NIHSS thresholds to an NIHSS score of 10 or more pre-thrombectomy. Some utilised an ASPECTs score of >6 as an entry criterion. It was the view of the committee that evidence on these clinical parameters will become clearer as experience with thrombectomy increases. The committee agreed that providing additional criteria to take into account when considering thrombectomy would be helpful for those setting up a new service and also a helpful guide for referring centres. Based on the evidence reviewed it was not possible to specify strict threshold criteria for eligibility based on pre-stroke functional status, clinical severity of stroke or the extent of established infarction on initial brain imaging. This is because there was variation in the trial entry criteria used in the studies and the committee agreed that these factors should be considered as part of the clinical judgment on an individual basis. However, it was important to make a recommendation that can be implemented in practice. Therefore, mRS and NIHSS eligibility thresholds have been included consistent with the NHS England Clinical Commissioing Policy: Mechanical thrombectomy for acute ischaemic stroke. No criteria have been set for the extent of established infarction because the ASPECTS score was not included in the commissioning document, nor was it used as an entry criteria in most of the clinical trials.</p><p>The committee noted that although the benefit in mRS appeared to increase at later thrombectomy time thresholds, this does not mean that it is better to wait and perform thrombectomy later after stroke onset. This effect could be a consequence of the stricter patient selection criteria used, because the trials including thrombectomy performed later after stroke onset used more advanced imaging. This increased selectivity would have resulted in a population with a greater chance of benefit from the intervention by identifying and including only those with a favourable collateral flow. The larger effect size in the later time thresholds might also be explained by the difference between the people in the control groups. People in the control arm presenting within 4.5 hours of stroke onset are eligible for thrombolysis, whereas beyond this time threshold and up until 24 hours of stroke onset, this treatment option is no longer available to the people in the control group, for whom aspirin may be the only option. The difference in mRS score between the thrombectomy and control Stroke and transient ischaemic attack in over 16s: evidence review D FINAL (May 2019) Endovascular therapy arms for those presenting within 6-24 hours of stroke onset may therefore be greater than the difference for those presenting 0-6 hours of stroke onset. The committee highlighted the need for rapid treatment for all patients with ischaemic stroke and that, when indicated, thrombectomy should be performed as soon as possible after presentation.</p><div id="ch4.s1.9.1.3.1"><h5>Posterior circulation stroke</h5><p>In the absence of evidence on the effectiveness and safety of thrombectomy compared to thrombolysis or standard care in the posterior circulation stroke population the committee agreed to make a consensus recommendation. They agreed that the prognosis is usually very poor in those with basilar artery occlusion, which accounts for approximately 95% of interventions for proximal posterior artery occlusions, with around an 80% mortality and as few as 2-5% making a full neurological recovery in the absence of recanalisation or reperfusion interventions. The committee agreed that in their experience the prevalent current practice is to consider intravenous thrombolysis and/or mechanical thrombectomy in these people and that good outcomes can be achieved. Diagnosis may be delayed because posterior circulation strokes can present non-focally and/or with a reduced conscious level, and so thrombectomy is often performed later than 6 hours after onset and good outcomes can still be achieved at this time. Stroke onset in this group should therefore be defined as sudden onset of focal neurological symptoms clinically localised to the PCA circulation or a sudden deterioration from initial minor symptoms.</p><p>The main potential risk of thrombectomy and thrombolysis in this population relates to outcomes of intervening when there is already established disabling ischaemic brain injury. For example, in basilar artery occlusions if there is irreversible bilateral damage to the pons, even if the basilar artery is opened the person may be left with “locked-in-syndrome” with complete face and body paralysis but clear consciousness. The committee agreed that it is standard practice to perform brain imaging and look for established tissue damage in the brain regions affected by the arterial occlusion, particularly in areas of the brain stem before intervening to avoid increasing the number of patients surviving with severe neurological disability. Imaging with CT perfusion or MR DWI techniques should be performed regardless of how soon after onset a person presents with posterior circulation stroke to demonstrate that there is salvageable brain tissue. Furthermore, even if there may be some salvageable brain tissue it is important to identify whether small but functionally critical areas of the posterior circulation have been damaged, although the committee acknowledge that this can be difficult to identify. A small infarct in specific areas, for example, in areas of the brain supplied by the basilar artery, can have devastating consequences for functional outcomes. The committee noted that MRI may be superior to CT perfusion for assessing critical areas of the brain stem, and that both modalities will sometimes be needed.</p><p>The committee also agreed that, as the technique is similar, it would be reasonable to extrapolate the lack of clinically significant harm for mortality and intracerebral haemorrhage seen in anterior circulation stroke evidence. Alongside the potential for benefit in a severely ill population this supports the use of thrombectomy and thrombolysis as soon as possible after presentation when appropriate.</p><p>In conclusion, given the poor outlook without intervention, clinical experience of good outcomes being achieved with intervention and supportive evidence from the anterior stroke population, the committee agreed that thrombectomy and thrombolysis should be considered. The population included in the recommendation is people last known well up to 24 hours previously with acute ischaemic stroke and confirmed occlusions of the proximal posterior circulation where potentially salvageable brain tissue has been demonstrated by imaging with MRI or CT techniques. It is also important to consider the initial NIHSS score and overall functional capacity prior to the stroke to determine suitability for this intervention. The committee did not make a research recommendation as they are aware of ongoing research in this area including the BEST trial and the BASICS (Basilar Artery International Cooperation Study) trial. BASICS is currently recruiting participants in Europe. The population is those with CTA or MRA confirmed basilar occlusion and people will be randomised between standard care with additional intra-arterial therapy within 6 hours of onset versus standard care alone.</p></div></div></div><div id="ch4.s1.9.2"><h4>1.9.2. Cost effectiveness and resource use</h4><p>The results of a published cost–utility analysis with a UK NHS perspective estimated that thrombectomy alongside intravenous thrombolysis (where appropriate) is cost effective compared with intravenous thrombolysis alone, when performed within six hours of stroke onset. The study estimated the incremental cost effectiveness ratio to be £7,648 per QALY gained with a 100% likelihood of being cost effective at both a £20,000 and £30,000 threshold. A second cost utility analysis with a UK NHS perspective estimated that thrombectomy and intravenous thrombolysis was dominant (more effective and less costly) compared with intravenous thrombolysis alone.</p><p>The economic studies considered the cost effectiveness of thrombectomy alongside intravenous thrombolysis (compared with intravenous thrombolysis alone) in a refined population of people presenting within 6 hours of stroke onset, who had already undergone CT angiography or MR angiography (to determine whether they might benefit from thrombectomy) prior to randomisation. While CT/MR angiography is necessary to perform thrombectomy, intravenous thrombolysis can be administered following a CT head with no contrast. The committee noted that the economic analyses did not include the costs of CT/MR angiography, as all people in the trials received imaging. The committee therefore considered the current NHS reference cost of £121 for CT angiography and £202 for MR angiography.</p><p>To consider how including the costs of CT/MR angiography might affect the cost effectiveness of mechanical thrombectomy within 0-6 hours of ischaemic stroke onset, the committee noted the results of a threshold analysis which showed that the cost of mechanical thrombectomy would need to increase by 139% to render it borderline cost effective at a cost effectiveness threshold of £20,000 per QALY. The committee was informed by a published modelling study which used data from the Sentinel Stroke National Audit Programme<sup><a href="#ch4.fn1">a</a></sup>. The modelling study indicates that 40% of people with CT-confirmed ischaemic stroke (presenting within 12 hours) are found to have an occlusion of a large artery on CT Angiography, and so are potentially eligible for thrombectomy. Therefore, to find one person potentially eligible for thrombectomy, 2.5 CT angiography scans would be required. The committee judged that including the costs of the 2.5 scans needed to find one person potentially eligible for thrombectomy in the intervention arm would be unlikely to change the results of the cost–utility analyses.</p><p>The committee was confident that the economic evidence accurately demonstrates that offering thrombectomy alongside intravenous thrombolysis (where not contraindicated) to people with confirmed occlusion of the proximal anterior circulation determined by CT/MR angiography is cost-effective compared with current practice (intravenous thrombolysis alone following a CT head with no contrast) and would therefore be a good use of NHS resources.</p><p>The results of a cost utility analysis with a UK NHS perspective demonstrated the cost effectiveness of thrombectomy and best medical therapy compared with best medical therapy alone, when performed between 6-24 hours after stroke onset. The study estimated the incremental cost effectiveness ratio to be £1,227 per QALY gained when thrombectomy was performed between 6-12 hours of stroke onset, £4,103 per QALY gained when performed within 6-16 hours of stroke onset and £2,984 per QALY gained when performed within 6-24 hours of stroke onset.</p><p>The population of the trials investigating thrombectomy in people presenting between 6 and 24 hours after stroke onset is refined to those that would benefit from thrombectomy compared with the entire population of people presenting in this later timeframe, as the inclusion criteria of the clinical trials specified that perfusion imaging was performed. The economic study therefore considered the cost effectiveness of thrombectomy, delivered in the later timeframe, in a population of people who had already undergone perfusion imaging.</p><p>The committee agreed that it was not current practice to offer perfusion imaging to all those presenting within 6-24 hours of onset of ischaemic stroke and so considered the costs of perfusion imaging in the context of the results of the cost utility analysis. Threshold analyses found that the cost of thrombectomy would need to exceed £35,517 using the efficacy data at 12 hours, £33,185 at 16 hours and £43,140 at 24 hours to be borderline cost effective at a cost effectiveness threshold of £20,000 per QALY gained. The committee estimated that 2-4 perfusion scans would need to be carried out to yield one person eligible for thrombectomy<sup><a href="#ch4.fn2">b</a></sup>. Using the results of the threshold analyses and the current unit costs of CT angiography and perfusion, the committee judged that including the costs of four additional scans in the thrombectomy arm would be unlikely to change the results of the cost–utility analysis.</p><p>The economic and clinical evidence informed the committee’s decision to make a strong recommendation to offer thrombectomy for people presenting between 6-24 hours of stroke onset, where occlusion of the proximal anterior circulation is confirmed and where potential benefit has been determined by further appropriate imaging with CT or MRI and appropriate clinical radiological mismatch.</p><p>No economic or clinical evidence was identified for the use of thrombectomy for posterior circulation stroke. The committee noted that around 5-10% of all strokes are in the posterior circulation. Prognosis is poor in basilar artery occlusion in the absence of reperfusion. The committee chose to make a consensus recommendation that thrombectomy alongside intravenous thrombolysis (where not contraindicated and within the licensed time window) is considered for those last known to be well up to 24 hours previously (including wake up strokes), aligning with current practice. thrombectomy should be considered only for those with salvageable brain tissue demonstrated with MRI or CT techniques. The committee stressed the need to demonstrate salvageable brain tissue in all people presenting up to 24 hours of stroke onset, as damage to functionally important areas of the brain could have a significant impact on functional outcomes. The committee thought that this would mitigate the risk of locked-in syndrome or other poor outcomes in this population.</p><p>The committee was aware of the significant change to current practice and the substantial resource impact which will arise from these recommendations. In current practice, around 10% of people presenting with stroke in the UK are eligible for thrombectomy. This population will likely increase as a result of these recommendations. The prevalence of thrombectomy is increasing; it is currently performed in most of the neuroscience centres in England. In addition, most neurointervention centres currently operate on a 9:00-17:00 basis. To implement these recommendations, radiographers and staff at neurointervention centres will be required 24 hours per day. The committee also discussed the possibility that the new recommendations could result in a large increase in referrals to centres which deliver thrombectomy services. The committee noted that there are likely to be additional costs incurred in transferring people to centres where thrombectomy is available. The new recommendations are therefore expected to result in a significant change from current practice, which is likely to have a substantial resource impact on the NHS. However, the committee were highly confident that increasing the provision of thrombectomy will be a cost effective use resources, due to the downstream cost savings it will produce such as decreased demand for rehabilitation, long term care and decompressive hemicraniectomies.</p><p>In conclusion, the committee agreed the cost effectiveness evidence accurately demonstrates that offering thrombectomy with best medical therapy beyond six hours of stroke and up to 24 hours after stroke onset as well as thrombectomy with intravenous thrombolysis within six hours of stroke onset would be an efficient use of NHS resources. No health economic evidence was identified for the cost effectiveness of thrombectomy for posterior circulation ischaemic stroke and a consensus recommendation to consider thrombectomy was made. The committee was aware of the significant up-front investment that will be required for the implementation of these recommendations.</p></div><div id="ch4.s1.9.3"><h4>1.9.3. Other factors the committee took into account</h4><p>The committee discussed age as an equality consideration and noted that three studies had inclusion criteria of up to 80 years of age, one at up to 85 and one of up to 90 years, the remaining studies included all those aged over 18 years old. The group considered that the evidence was applicable to the population of those aged 16 years and over with no separate recommendations for any age group and no upper age limit. It was also noted that the included studies allowed clinical judgement about the use of general anaesthetic when performing thrombectomy.</p><p>Current practice is for IV thrombolysis administered as soon as ischaemic stroke is diagnosed, if the patient is within 4.5 hours of onset of symptoms and has no contraindications. Thrombectomy should then be undertaken if appropriate, checking as the procedure is about to start whether the thrombolysis has already achieved recovery and the thrombectomy is no longer required. Access to thrombectomy services varies across the country; rapid access remains a logistical challenge with different pathway models under evaluation. The committee discussed that few centres offer a 24-hour service and that most operate within 9 to 5 working hours Monday to Friday. It was also noted that staff at district general hospitals will always contact a stroke or neurointerventional specialist before deciding to transfer the patient for thrombectomy. The receiving centres will decide whether or not there would be a benefit of thrombectomy based on imaging evidence and the clinical scenario. Detailed consideration of detection of salvageable tissue was considered to be beyond the scope of this guideline. The optimal neuroimaging pathways should be determined by individual clinical networks based on local expertise and resources.</p><p>The committee discussed implementation of this recommendation and that this would increase the numbers of people undergoing thrombectomy, particularly those with stroke onset more than 6 hours prior to possible intervention. This may require more specialist centres or increased transport to areas where this procedure can be performed, and may present challenges for implementation, including access to imaging (in particular CT angiography) to select those who can benefit from treatment. A practical approach to implementation may be for District General Hospitals to perform further imaging and for reporting to be done by the specialist centre. Also, the CTA should be performed immediately after the plain CT once haemorrhage is excluded to avoid a second visit to the CT scanner. Regarding CT perfusion, the committee discussed that this is not currently performed in all areas but that most CT scanners can accommodate this technique with an appropriate software package. The only additional requirement would be a second injection after the CTA.</p><p>The committee noted the risk that if further imaging with CT or MRI is not available, people who would be eligible may not receive thrombectomy. They also noted that with CT perfusion, blood volume maps may be useful to predict infarction and in DWI MRI, lesions with low apparent diffusion coefficient (ADC) values predict early infarction.</p><p>The current model is to access local stroke centre for diagnosis and intravenous thrombolysis and transfer to a specialist thrombectomy centre. Service models include ‘mother ship’ model where all cases are triaged to a very large stroke centre with centralisation, which may be better for urban areas; and the ‘drip and ship’ models where the IV thrombolysis is started in the spoke hospital pending transfer to the larger centre (hub). Optimal networked arrangements will depend on the geography of region.</p><p>NICE have published other guidance which is relevant to this review:
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<ul id="l94"><li id="lt271" class="half_rhythm"><div><a href="https://www.nice.org.uk/guidance/ipg548" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Mechanical clot retrieval for treating acute ischaemic stroke (IPG548)</a>; and</div></li><li id="lt272" class="half_rhythm"><div><a href="https://www.nice.org.uk/guidance/ta264" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Alteplase for treating acute ischaemic stroke(TA264)</a>.</div></li></ul></p></div></div></div><div id="ch4.rl.r1"><h2 id="_ch4_rl_r1_">References</h2><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="ch4.ref1">Abou-Chebl
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J. Cost-effectiveness of mechanical thrombectomy for acute ischemic stroke: an Australian payer perspective. Journal of Medical Economics. 2018; 21(8):799–809 [<a href="https://pubmed.ncbi.nlm.nih.gov/29741126" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29741126</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>12.</dt><dd><div class="bk_ref" id="ch4.ref12">Assis
|
|
Z, Menon
|
|
BK, Goyal
|
|
M, Demchuk
|
|
AM, Shankar
|
|
J, Rempel
|
|
JL
|
|
et al. Acute ischemic stroke with tandem lesions: technical endovascular management and clinical outcomes from the ESCAPE trial. Journal of Neurointerventional Surgery. 2018; 10(5):429–33 [<a href="https://pubmed.ncbi.nlm.nih.gov/29021311" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29021311</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>13.</dt><dd><div class="bk_ref" id="ch4.ref13">Baek
|
|
JM, Yoon
|
|
W, Kim
|
|
SK, Jung
|
|
MY, Park
|
|
MS, Kim
|
|
JT
|
|
et al. Acute basilar artery occlusion: outcome of mechanical thrombectomy with Solitaire stent within 8 hours of stroke onset. American Journal of Neuroradiology. 2014; 35(5):989–93 [<a href="/pmc/articles/PMC7964531/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7964531</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24335542" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24335542</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>14.</dt><dd><div class="bk_ref" id="ch4.ref14">Becktepe
|
|
JS, You
|
|
SJ, Berkefeld
|
|
J, Neumann-Haefelin
|
|
T, Singer
|
|
OC. Clinical outcome after mechanical recanalization as mono- or adjunctive therapy in acute stroke: importance of time to recanalization. Cerebrovascular Diseases. 2011; 32(3):211–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/21860233" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21860233</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>15.</dt><dd><div class="bk_ref" id="ch4.ref15">Berkhemer
|
|
OA, Fransen
|
|
PSS, Beumer
|
|
D, Van Den Berg
|
|
LA, Lingsma
|
|
HF, Yoo
|
|
AJ
|
|
et al. A randomized trial of intraarterial treatment for acute ischemic stroke. New England Journal of Medicine. 2015; 372(1):11–20 [<a href="https://pubmed.ncbi.nlm.nih.gov/25517348" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25517348</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>16.</dt><dd><div class="bk_ref" id="ch4.ref16">Bouvy
|
|
JC, Fransen
|
|
PS, Baeten
|
|
SA, Koopmanschap
|
|
MA, Niessen
|
|
LW, Dippel
|
|
DW. Cost-effectiveness of two endovascular treatment strategies vs intravenous thrombolysis. Acta Neurologica Scandinavica. 2013; 127(5):351–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/23278859" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23278859</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>17.</dt><dd><div class="bk_ref" id="ch4.ref17">Bracard
|
|
S, Ducrocq
|
|
X, Mas
|
|
JL, Soudant
|
|
M, Oppenheim
|
|
C, Moulin
|
|
T
|
|
et al. Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial. Lancet Neurology. 2016; 15(11):1138–47 [<a href="https://pubmed.ncbi.nlm.nih.gov/27567239" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27567239</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>18.</dt><dd><div class="bk_ref" id="ch4.ref18">Broderick
|
|
JP, Berkhemer
|
|
OA, Palesch
|
|
YY, Dippel
|
|
DW, Foster
|
|
LD, Roos
|
|
YB
|
|
et al. Endovascular therapy is effective and safe for patients with severe ischemic stroke: Pooled analysis of Interventional Management of Stroke III and Multicenter Randomized Clinical Trial of Endovascular Therapy for Acute Ischemic Stroke in the Netherlands data. Stroke. 2015; 46(12):3416–22 [<a href="/pmc/articles/PMC4659737/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4659737</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26486865" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26486865</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>19.</dt><dd><div class="bk_ref" id="ch4.ref19">Broussalis
|
|
E, Hitzl
|
|
W, McCoy
|
|
M, Trinka
|
|
E, Killer
|
|
M. Comparison of endovascular treatment versus conservative medical treatment in patients with acute basilar artery occlusion. Vascular and Endovascular Surgery. 2013; 47(6):429–37 [<a href="https://pubmed.ncbi.nlm.nih.gov/23690536" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23690536</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>20.</dt><dd><div class="bk_ref" id="ch4.ref20">Campbell
|
|
BC, Hill
|
|
MD, Rubiera
|
|
M, Menon
|
|
BK, Demchuk
|
|
A, Donnan
|
|
GA
|
|
et al. Safety and efficacy of Solitaire stent thrombectomy: Individual patient data meta-analysis of randomized trials. Stroke. 2016; 47(3):798–806 [<a href="/pmc/articles/PMC4760381/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4760381</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26888532" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26888532</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>21.</dt><dd><div class="bk_ref" id="ch4.ref21">Campbell
|
|
BC, Mitchell
|
|
PJ, Kleinig
|
|
TJ, Dewey
|
|
HM, Churilov
|
|
L, Yassi
|
|
N
|
|
et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. New England Journal of Medicine. 2015; 372(11):1009–18 [<a href="https://pubmed.ncbi.nlm.nih.gov/25671797" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25671797</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>22.</dt><dd><div class="bk_ref" id="ch4.ref22">Campbell
|
|
BCV, Mitchell
|
|
PJ, Churilov
|
|
L, Keshtkaran
|
|
M, Hong
|
|
KS, Kleinig
|
|
TJ
|
|
et al. Endovascular thrombectomy for ischemic stroke increases disability-free survival, quality of life, and life expectancy and reduces cost. Frontiers in Neurology. 2017; 8:657 [<a href="/pmc/articles/PMC5735082/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5735082</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29312109" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29312109</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>23.</dt><dd><div class="bk_ref" id="ch4.ref23">Chung
|
|
H, Refoios Camejo
|
|
R, Barnett
|
|
D. Alteplase for the treatment of acute ischaemic stroke: NICE technology appraisal guidance. Heart. 2007; 93(12):1616–7 [<a href="/pmc/articles/PMC2095758/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2095758</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/18003692" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18003692</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>24.</dt><dd><div class="bk_ref" id="ch4.ref24">Ciccone
|
|
A, Valvassori
|
|
L, Nichelatti
|
|
M, Sgoifo
|
|
A, Ponzio
|
|
M, Sterzi
|
|
R
|
|
et al. Endovascular treatment for acute ischemic stroke. New England Journal of Medicine. 2013; 368(10):904–13 [<a href="/pmc/articles/PMC3708480/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3708480</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23387822" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23387822</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>25.</dt><dd><div class="bk_ref" id="ch4.ref25">Costalat
|
|
V, Lobotesis
|
|
K, Machi
|
|
P, Mourand
|
|
I, Maldonado
|
|
I, Heroum
|
|
C
|
|
et al. Prognostic factors related to clinical outcome following thrombectomy in ischemic stroke (RECOST study). 50 patients prospective study. European Journal of Radiology. 2012; 81(12):4075–82 [<a href="https://pubmed.ncbi.nlm.nih.gov/22940230" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22940230</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>26.</dt><dd><div class="bk_ref" id="ch4.ref26">Costalat
|
|
V, Machi
|
|
P, Lobotesis
|
|
K, Maldonado
|
|
I, Vendrell
|
|
JF, Riquelme
|
|
C
|
|
et al. Rescue, combined, and stand-alone thrombectomy in the management of large vessel occlusion stroke using the Solitaire device: a prospective 50-patient single-center study: timing, safety, and efficacy. Stroke. 2011; 42(7):1929–35 [<a href="https://pubmed.ncbi.nlm.nih.gov/21597019" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21597019</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>27.</dt><dd><div class="bk_ref" id="ch4.ref27">Coutinho
|
|
JM, Liebeskind
|
|
DS, Slater
|
|
LA, Nogueira
|
|
RG, Clark
|
|
W, Davalos
|
|
A
|
|
et al. Combined intravenous thrombolysis and thrombectomy vs thrombectomy alone for acute ischemic stroke: A pooled analysis of the swift and star studies. JAMA Neurology. 2017; 74(3):268–274 [<a href="https://pubmed.ncbi.nlm.nih.gov/28097310" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28097310</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>28.</dt><dd><div class="bk_ref" id="ch4.ref28">Davalos
|
|
A, Cobo
|
|
E, Molina
|
|
CA, Chamorro
|
|
A, de Miquel
|
|
MA, Roman
|
|
LS
|
|
et al. Safety and efficacy of thrombectomy in acute ischaemic stroke (REVASCAT): 1-year follow-up of a randomised open-label trial. Lancet Neurology. 2017; 16(5):369–76 [<a href="https://pubmed.ncbi.nlm.nih.gov/28318984" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28318984</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>29.</dt><dd><div class="bk_ref" id="ch4.ref29">de Andres-Nogales
|
|
F, Alvarez
|
|
M, de Miquel
|
|
MA, Segura
|
|
T, Gil
|
|
A, Cardona
|
|
P
|
|
et al. Cost-effectiveness of mechanical thrombectomy using stent retriever after intravenous tissue plasminogen activator compared with intravenous tissue plasminogen activator alone in the treatment of acute ischaemic stroke due to large vessel occlusion in Spain. European Stroke Journal. 2017; 2(3):272–84 [<a href="/pmc/articles/PMC6454829/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6454829</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31008321" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31008321</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>30.</dt><dd><div class="bk_ref" id="ch4.ref30">Demchuk
|
|
AM, Goyal
|
|
M, Menon
|
|
BK, Eesa
|
|
M, Ryckborst
|
|
KJ, Kamal
|
|
N
|
|
et al. Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing CT to recanalization times (ESCAPE) trial: methodology. International Journal of Stroke. 2015; 10(3):429–38 [<a href="https://pubmed.ncbi.nlm.nih.gov/25546514" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25546514</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>31.</dt><dd><div class="bk_ref" id="ch4.ref31">Dias
|
|
FA, Alessio-Alves
|
|
FF, Castro-Afonso
|
|
LH, Cougo
|
|
PT, Barreira
|
|
CMA, Camilo
|
|
MR
|
|
et al. Clinical outcomes of patients with acute basilar artery occlusion in Brazil: an observational study. Journal of Stroke and Cerebrovascular Diseases. 2017; 26(10):2191–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/28551292" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28551292</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>32.</dt><dd><div class="bk_ref" id="ch4.ref32">Diener
|
|
HC, Nitschmann
|
|
S. Endovascular treatment for acute ischemic stroke: Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN). Internist. 2015; 56(7):847–50 [<a href="https://pubmed.ncbi.nlm.nih.gov/26016994" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26016994</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>33.</dt><dd><div class="bk_ref" id="ch4.ref33">Dorman
|
|
PJ, Waddell
|
|
F, Slattery
|
|
J, Dennis
|
|
M, Sandercock
|
|
P. Is the EuroQol a valid measure of health-related quality of life after stroke?
|
|
Stroke. 1997; 28(10):1876–82 [<a href="https://pubmed.ncbi.nlm.nih.gov/9341688" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9341688</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>34.</dt><dd><div class="bk_ref" id="ch4.ref34">Dorn
|
|
F, Stehle
|
|
S, Lockau
|
|
H, Zimmer
|
|
C, Liebig
|
|
T. Endovascular treatment of acute intracerebral artery occlusions with the solitaire stent: single-centre experience with 108 recanalization procedures. Cerebrovascular Diseases. 2012; 34(1):70–7 [<a href="https://pubmed.ncbi.nlm.nih.gov/22759754" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22759754</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>35.</dt><dd><div class="bk_ref" id="ch4.ref35">Dornak
|
|
T, Herzig
|
|
R, Kuliha
|
|
M, Havlicek
|
|
R, Skoloudik
|
|
D, Sanak
|
|
D
|
|
et al. Endovascular treatment of acute basilar artery occlusion: Time to treatment is crucial. Clinical Radiology. 2015; 70(5):e20–e27 [<a href="https://pubmed.ncbi.nlm.nih.gov/25703459" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25703459</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>36.</dt><dd><div class="bk_ref" id="ch4.ref36">Ecker-Schlipf
|
|
B. Acute ischemic stroke - The ECASS III Study: Alteplase is effective and safe even when administered after 3 to 4.5 hours. Arzneimitteltherapie. 2009; 27(2):56–7</div></dd></dl><dl class="bkr_refwrap"><dt>37.</dt><dd><div class="bk_ref" id="ch4.ref37">Fransen
|
|
PS, Beumer
|
|
D, Berkhemer
|
|
OA, van den Berg
|
|
LA, Lingsma
|
|
H, van der Lugt
|
|
A
|
|
et al. MR CLEAN, a multicenter randomized clinical trial of endovascular treatment for acute ischemic stroke in the Netherlands: study protocol for a randomized controlled trial. Trials. 2014; 15:343 [<a href="/pmc/articles/PMC4162915/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4162915</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25179366" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25179366</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>38.</dt><dd><div class="bk_ref" id="ch4.ref38">Ganesalingam
|
|
J, Pizzo
|
|
E, Morris
|
|
S, Sunderland
|
|
T, Ames
|
|
D, Lobotesis
|
|
K. Cost-utility analysis of mechanical thrombectomy using stent retrievers in acute ischemic stroke. Stroke. 2015; 46(9):2591–8 [<a href="/pmc/articles/PMC4542565/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4542565</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26251241" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26251241</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>39.</dt><dd><div class="bk_ref" id="ch4.ref39">Ganesh
|
|
A, Al-Ajlan
|
|
FS, Sabiq
|
|
F, Assis
|
|
Z, Rempel
|
|
JL, Butcher
|
|
K
|
|
et al. Infarct in a new territory after treatment administration in the ESCAPE randomized controlled trial (Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing CT to recanalization times). Stroke. 2016; 47(12):2993–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/27834743" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27834743</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>40.</dt><dd><div class="bk_ref" id="ch4.ref40">Gerber
|
|
JC, Daubner
|
|
D, Kaiser
|
|
D, Engellandt
|
|
K, Haedrich
|
|
K, Mueller
|
|
A
|
|
et al. Efficacy and safety of direct aspiration first pass technique versus stent-retriever thrombectomy in acute basilar artery occlusion-a retrospective single center experience. Neuroradiology. 2017; 59(3):297–304 [<a href="https://pubmed.ncbi.nlm.nih.gov/28251328" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28251328</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>41.</dt><dd><div class="bk_ref" id="ch4.ref41">Gory
|
|
B, Eldesouky
|
|
I, Sivan-Hoffmann
|
|
R, Rabilloud
|
|
M, Ong
|
|
E, Riva
|
|
R
|
|
et al. Outcomes of stent retriever thrombectomy in basilar artery occlusion: an observational study and systematic review. Journal of Neurology, Neurosurgery and Psychiatry. 2016; 87(5):520–5 [<a href="https://pubmed.ncbi.nlm.nih.gov/25986363" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25986363</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>42.</dt><dd><div class="bk_ref" id="ch4.ref42">Goyal
|
|
M, Demchuk
|
|
AM, Menon
|
|
BK, Eesa
|
|
M, Rempel
|
|
JL, Thornton
|
|
J
|
|
et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. New England Journal of Medicine. 2015; 372(11):1019–30 [<a href="https://pubmed.ncbi.nlm.nih.gov/25671798" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25671798</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>43.</dt><dd><div class="bk_ref" id="ch4.ref43">Goyal
|
|
M, Menon
|
|
BK, van Zwam
|
|
WH, Dippel
|
|
DW, Mitchell
|
|
PJ, Demchuk
|
|
AM
|
|
et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016; 387(10029):1723–31 [<a href="https://pubmed.ncbi.nlm.nih.gov/26898852" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26898852</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>44.</dt><dd><div class="bk_ref" id="ch4.ref44">Haussen
|
|
DC, Lima
|
|
FO, Bouslama
|
|
M, Grossberg
|
|
JA, Silva
|
|
GS, Lev
|
|
MH
|
|
et al. Thrombectomy versus medical management for large vessel occlusion strokes with minimal symptoms: an analysis from STOPStroke and GESTOR cohorts. Journal of Neurointerventional Surgery. 2018; 10:325–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/28768820" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28768820</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>45.</dt><dd><div class="bk_ref" id="ch4.ref45">He
|
|
X, Zhang
|
|
L, Yang
|
|
J, Zheng
|
|
H, Li
|
|
K, Liu
|
|
Y. Multimodal therapy for non-superacute vertebral basilar artery occlusion. Interventional Neurology. 2017; 6(3-4):254–62 [<a href="/pmc/articles/PMC5662983/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5662983</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29118803" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29118803</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>46.</dt><dd><div class="bk_ref" id="ch4.ref46">Health Quality Ontario. Mechanical thrombectomy in patients with acute ischemic stroke: A health technology assessment. Ontario. Health Quality Ontario, 2016. Available from: <a href="http://www.hqontario.ca/Evidence-to-Improve-Care/Health-Technology-Assessment/Reviews-And-Recommendations/Mechanical-Thrombectomy-for-Patients-with-Acute-Ischemic-Stroke" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.hqontario<wbr style="display:inline-block"></wbr>​.ca/Evidence-to-Improve-Care<wbr style="display:inline-block"></wbr>​/Health-Technology-Assessment<wbr style="display:inline-block"></wbr>​/Reviews-And-Recommendations<wbr style="display:inline-block"></wbr>​/Mechanical-Thrombectomy-for-Patients-with-Acute-Ischemic-Stroke</a> [<a href="/pmc/articles/PMC4761918/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4761918</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27026799" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27026799</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>47.</dt><dd><div class="bk_ref" id="ch4.ref47">Heshmatollah
|
|
A, Fransen
|
|
PSS, Berkhemer
|
|
OA, Beumer
|
|
D, van der Lugt
|
|
A, Majoie
|
|
C
|
|
et al. Endovascular thrombectomy in patients with acute ischaemic stroke and atrial fibrillation: a MR CLEAN subgroup analysis. EuroIntervention. 2017; 13(8):996–1002 [<a href="https://pubmed.ncbi.nlm.nih.gov/28649948" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28649948</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>48.</dt><dd><div class="bk_ref" id="ch4.ref48">Hong
|
|
JH, Sohn
|
|
SI, Kang
|
|
J, Jang
|
|
MU, Kim
|
|
BJ, Han
|
|
MK
|
|
et al. Endovascular treatment in patients with persistent internal carotid artery occlusion after intravenous tissue plasminogen activator: A clinical effectiveness study. Cerebrovascular Diseases. 2016; 42(5-6):387–94 [<a href="https://pubmed.ncbi.nlm.nih.gov/27359223" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27359223</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>49.</dt><dd><div class="bk_ref" id="ch4.ref49">Hunter
|
|
RM, Davie
|
|
C, Rudd
|
|
A, Thompson
|
|
A, Walker
|
|
H, Thomson
|
|
N
|
|
et al. Impact on clinical and cost outcomes of a centralized approach to acute stroke care in London: a comparative effectiveness before and after model. PloS One. 2013; 8(8):e70420 [<a href="/pmc/articles/PMC3731285/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3731285</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23936427" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23936427</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>50.</dt><dd><div class="bk_ref" id="ch4.ref50">Jeong
|
|
HS, Shin
|
|
JW, Kwon
|
|
HJ, Koh
|
|
HS, Nam
|
|
HS, Yu
|
|
HS
|
|
et al. Cost benefits of rapid recanalization using intraarterial thrombectomy. Brain and Behavior. 2017; 7(10):e00830 [<a href="/pmc/articles/PMC5651400/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5651400</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29075576" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29075576</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>51.</dt><dd><div class="bk_ref" id="ch4.ref51">Jovin
|
|
TG, Chamorro
|
|
A, Cobo
|
|
E, de Miquel
|
|
MA, Molina
|
|
CA, Rovira
|
|
A
|
|
et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. New England Journal of Medicine. 2015; 372(24):2296–306 [<a href="https://pubmed.ncbi.nlm.nih.gov/25882510" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25882510</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>52.</dt><dd><div class="bk_ref" id="ch4.ref52">Khatri
|
|
P, Mocco
|
|
J, Zaidat
|
|
O, Gupta
|
|
R, Kummer
|
|
R. THERAPY: a prospective, randomized trial to assess mechanical thrombectomy as adjunctive treatment to IV rtPA in acute ischemic stroke. Journal of Neurointerventional Surgery. 2013; 5:(Suppl 2):A53–54</div></dd></dl><dl class="bkr_refwrap"><dt>53.</dt><dd><div class="bk_ref" id="ch4.ref53">Khoury
|
|
NN, Darsaut
|
|
TE, Ghostine
|
|
J, Deschaintre
|
|
Y, Daneault
|
|
N, Durocher
|
|
A
|
|
et al. Endovascular thrombectomy and medical therapy versus medical therapy alone in acute stroke: A randomized care trial. Journal of Neuroradiology. 2017; 44(3):198–202 [<a href="https://pubmed.ncbi.nlm.nih.gov/28238522" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28238522</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>54.</dt><dd><div class="bk_ref" id="ch4.ref54">Kidwell
|
|
CS, Jahan
|
|
R, Alger
|
|
JR, Schaewe
|
|
TJ, Guzy
|
|
J, Starkman
|
|
S
|
|
et al. Design and rationale of the Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy (MR RESCUE) Trial. International Journal of Stroke. 2014; 9(1):110–6 [<a href="/pmc/articles/PMC3525782/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3525782</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/22974139" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22974139</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>55.</dt><dd><div class="bk_ref" id="ch4.ref55">Kidwell
|
|
CS, Jahan
|
|
R, Gornbein
|
|
J, Alger
|
|
JR, Nenov
|
|
V, Ajani
|
|
Z
|
|
et al. A trial of imaging selection and endovascular treatment for ischemic stroke. New England Journal of Medicine. 2013; 368(10):914–23 [<a href="/pmc/articles/PMC3690785/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3690785</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23394476" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23394476</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>56.</dt><dd><div class="bk_ref" id="ch4.ref56">Kim
|
|
BJ, Han
|
|
MK, Park
|
|
TH, Park
|
|
SS, Lee
|
|
KB, Lee
|
|
BC
|
|
et al. Trends in the effectiveness of endovascular recanalization for acute stroke: is a change taking place?
|
|
Journal of Stroke and Cerebrovascular Diseases. 2015; 24(4):866–73 [<a href="https://pubmed.ncbi.nlm.nih.gov/25726023" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25726023</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>57.</dt><dd><div class="bk_ref" id="ch4.ref57">Kocher
|
|
M, Dornak
|
|
T, Sanak
|
|
D, Cerna
|
|
M, Burval
|
|
S, Prasil
|
|
V
|
|
et al. Endovascular treatment of ischemic stroke in vertebrobasilar territory. Ceska Radiologie. 2014; 68(2):107–12</div></dd></dl><dl class="bkr_refwrap"><dt>58.</dt><dd><div class="bk_ref" id="ch4.ref58">Kumar
|
|
G, Shahripour
|
|
RB, Alexandrov
|
|
AV. Recanalization of acute basilar artery occlusion improves outcomes: a meta-analysis. Journal of Neurointerventional Surgery. 2015; 7(12):868–74 [<a href="https://pubmed.ncbi.nlm.nih.gov/25271064" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25271064</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>59.</dt><dd><div class="bk_ref" id="ch4.ref59">Lefevre
|
|
PH, Lainay
|
|
C, Thouant
|
|
P, Chavent
|
|
A, Kazemi
|
|
A, Ricolfi
|
|
F. Solitaire FR as a first-line device in acute intracerebral occlusion: a single-centre retrospective analysis. Journal of Neuroradiology Journal de Neuroradiologie. 2014; 41(1):80–6 [<a href="https://pubmed.ncbi.nlm.nih.gov/24388566" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24388566</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>60.</dt><dd><div class="bk_ref" id="ch4.ref60">Liu
|
|
X, Xu
|
|
G, Liu
|
|
Y, Zhu
|
|
W, Ma
|
|
M, Xiong
|
|
Y
|
|
et al. Acute basilar artery occlusion: Endovascular Interventions versus Standard Medical Treatment (BEST) Trial-Design and protocol for a randomized, controlled, multicenter study. International Journal of Stroke. 2017; 12(7):779–785 [<a href="https://pubmed.ncbi.nlm.nih.gov/28361616" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28361616</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>61.</dt><dd><div class="bk_ref" id="ch4.ref61">Lobotesis
|
|
K, Veltkamp
|
|
R, Carpenter
|
|
IH, Claxton
|
|
LM, Saver
|
|
JL, Hodgson
|
|
R. Cost-effectiveness of stent-retriever thrombectomy in combination with IV t-PA compared with IV t-PA alone for acute ischemic stroke in the UK. Journal of Medical Economics. 2016; 19(8):785–94 [<a href="https://pubmed.ncbi.nlm.nih.gov/27046347" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27046347</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>62.</dt><dd><div class="bk_ref" id="ch4.ref62">Maier
|
|
IL, Behme
|
|
D, Schnieder
|
|
M, Tsogkas
|
|
I, Schregel
|
|
K, Kleinknecht
|
|
A
|
|
et al. Bridging-therapy with intravenous recombinant tissue plasminogen activator improves functional outcome in patients with endovascular treatment in acute stroke. Journal of the Neurological Sciences. 2017; 372:300–4 [<a href="https://pubmed.ncbi.nlm.nih.gov/28017233" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28017233</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>63.</dt><dd><div class="bk_ref" id="ch4.ref63">Mazighi
|
|
M, Serfaty
|
|
JM, Labreuche
|
|
J, Laissy
|
|
JP, Meseguer
|
|
E, Lavallee
|
|
PC
|
|
et al. Comparison of intravenous alteplase with a combined intravenous-endovascular approach in patients with stroke and confirmed arterial occlusion (RECANALISE study): a prospective cohort study. Lancet Neurology. 2009; 8(9):802–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/19647488" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19647488</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>64.</dt><dd><div class="bk_ref" id="ch4.ref64">Menjot de Champfleur
|
|
N, Saver
|
|
JL, Goyal
|
|
M, Jahan
|
|
R, Diener
|
|
HC, Bonafe
|
|
A
|
|
et al. Efficacy of stent-retriever thrombectomy in magnetic resonance imaging versus computed tomographic perfusion-selected patients in SWIFT PRIME Trial (Solitaire FR With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke). Stroke. 2017; 48(6):1560–6 [<a href="https://pubmed.ncbi.nlm.nih.gov/28465460" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28465460</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>65.</dt><dd><div class="bk_ref" id="ch4.ref65">Mistry
|
|
EA, Mistry
|
|
AM, Nakawah
|
|
MO, Chitale
|
|
RV, James
|
|
RF, Volpi
|
|
JJ
|
|
et al. Mechanical thrombectomy outcomes with and without intravenous thrombolysis in stroke patients: A meta-analysis. Stroke. 2017; 48(9):2450–6 [<a href="https://pubmed.ncbi.nlm.nih.gov/28747462" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28747462</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>66.</dt><dd><div class="bk_ref" id="ch4.ref66">Mocco
|
|
J, Zaidat
|
|
OO, von Kummer
|
|
R, Yoo
|
|
AJ, Gupta
|
|
R, Lopes
|
|
D
|
|
et al. Aspiration thrombectomy after intravenous alteplase versus intravenous alteplase alone. Stroke. 2016; 47(9):2331–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/27486173" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27486173</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>67.</dt><dd><div class="bk_ref" id="ch4.ref67">Molina
|
|
CA, Chamorro
|
|
A, Rovira
|
|
A, de Miquel
|
|
A, Serena
|
|
J, Roman
|
|
LS
|
|
et al. REVASCAT: a randomized trial of revascularization with SOLITAIRE FR device vs. best medical therapy in the treatment of acute stroke due to anterior circulation large vessel occlusion presenting within eight-hours of symptom onset. International Journal of Stroke. 2015; 10(4):619–26 [<a href="https://pubmed.ncbi.nlm.nih.gov/24206399" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24206399</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>68.</dt><dd><div class="bk_ref" id="ch4.ref68">Mordasini
|
|
P, Brekenfeld
|
|
C, Byrne
|
|
JV, Fischer
|
|
U, Arnold
|
|
M, Heldner
|
|
MR
|
|
et al. Technical feasibility and application of mechanical thrombectomy with the Solitaire FR Revascularization Device in acute basilar artery occlusion. American Journal of Neuroradiology. 2013; 34(1):159–63 [<a href="/pmc/articles/PMC7966341/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7966341</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/22723058" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22723058</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>69.</dt><dd><div class="bk_ref" id="ch4.ref69">Mortimer
|
|
AM, Bradley
|
|
M, Renowden
|
|
SA. Endovascular therapy for acute basilar artery occlusion: A review of the literature. Journal of Neurointerventional Surgery. 2012; 4(4):266–73 [<a href="https://pubmed.ncbi.nlm.nih.gov/21990530" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21990530</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>70.</dt><dd><div class="bk_ref" id="ch4.ref70">Mourand
|
|
I, Machi
|
|
P, Milhaud
|
|
D, Picot
|
|
MC, Lobotesis
|
|
K, Arquizan
|
|
C
|
|
et al. Mechanical thrombectomy with the Solitaire device in acute basilar artery occlusion. Journal of Neurointerventional Surgery. 2014; 6(3):200–4 [<a href="https://pubmed.ncbi.nlm.nih.gov/23645572" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23645572</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>71.</dt><dd><div class="bk_ref" id="ch4.ref71">Muir
|
|
KW, Ford
|
|
GA, Messow
|
|
CM, Ford
|
|
I, Murray
|
|
A, Clifton
|
|
A
|
|
et al. Endovascular therapy for acute ischaemic stroke: the Pragmatic Ischaemic Stroke Thrombectomy Evaluation (PISTE) randomised, controlled trial. Journal of Neurology, Neurosurgery and Psychiatry. 2017; 88(1):38–44 [<a href="/pmc/articles/PMC5256149/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5256149</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27756804" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27756804</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>72.</dt><dd><div class="bk_ref" id="ch4.ref72">Mulder
|
|
MJ, Berkhemer
|
|
OA, Fransen
|
|
PS, Beumer
|
|
D, van den Berg
|
|
LA, Lingsma
|
|
HF
|
|
et al. Treatment in patients who are not eligible for intravenous alteplase: MR CLEAN subgroup analysis. International Journal of Stroke. 2016; 11(6):637–45 [<a href="https://pubmed.ncbi.nlm.nih.gov/27048692" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27048692</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>73.</dt><dd><div class="bk_ref" id="ch4.ref73">Nagel
|
|
S, Kellert
|
|
L, Mohlenbruch
|
|
M, Bosel
|
|
J, Rohde
|
|
S, Ringleb
|
|
P. Improved clinical outcome after acute basilar artery occlusion since the introduction of endovascular thrombectomy devices. Cerebrovascular Diseases. 2013; 36:394–400 [<a href="https://pubmed.ncbi.nlm.nih.gov/24246933" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24246933</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>74.</dt><dd><div class="bk_ref" id="ch4.ref74">National Institute for Health and Care Excellence. Developing NICE guidelines: the manual. London. National Institute for Health and Care Excellence, 2014. Available from: <a href="http://www.nice.org.uk/article/PMG20/chapter/1%20Introduction%20and%20overview" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.nice.org.uk<wbr style="display:inline-block"></wbr>​/article/PMG20/chapter<wbr style="display:inline-block"></wbr>​/1%20Introduction%20and%20overview</a> [<a href="https://pubmed.ncbi.nlm.nih.gov/26677490" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26677490</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>75.</dt><dd><div class="bk_ref" id="ch4.ref75">National Institute for Health and Clinical Excellence. Alteplase for treating acute ischaemic stroke (review of technology appraisal guidance 122). NICE technology appraisal guidance 264. London. National Institute for Health and Clinical Excellence, 2012. Available from: <a href="http://guidance.nice.org.uk/TA264" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://guidance<wbr style="display:inline-block"></wbr>​.nice.org.uk/TA264</a></div></dd></dl><dl class="bkr_refwrap"><dt>76.</dt><dd><div class="bk_ref" id="ch4.ref76">Nogueira
|
|
RG, Jadhav
|
|
AP, Haussen
|
|
DC, Bonafe
|
|
A, Budzik
|
|
RF, Bhuva
|
|
P
|
|
et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. New England Journal of Medicine. 2018; 378(1):11–21 [<a href="https://pubmed.ncbi.nlm.nih.gov/29129157" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29129157</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>77.</dt><dd><div class="bk_ref" id="ch4.ref77">Nogueira
|
|
RG, Lutsep
|
|
HL, Gupta
|
|
R, Jovin
|
|
TG, Albers
|
|
GA, Liebeskind
|
|
DL. Results from the TREVO 2 study (thrombectomy revascularisation of large vessel occlusions in acute ischemic stroke): randomized data comparing Trevo with Merci for thrombectomy in acute stroke. Cerebrovascular Diseases. 2012; 33:(Suppl 2):57 [<a href="/pmc/articles/PMC4176618/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4176618</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/22932714" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22932714</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>78.</dt><dd><div class="bk_ref" id="ch4.ref78">Nogueira
|
|
RG, Lutsep
|
|
HL, Gupta
|
|
R, Jovin
|
|
TG, Albers
|
|
GW, Walker
|
|
GA
|
|
et al. Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet. 2012; 380(9849):1231–40 [<a href="/pmc/articles/PMC4176618/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4176618</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/22932714" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22932714</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>79.</dt><dd><div class="bk_ref" id="ch4.ref79">O’Rourke
|
|
K, Berge
|
|
E, Walsh
|
|
CD, Kelly
|
|
PJ. Percutaneous vascular interventions for acute ischaemic stroke. Cochrane Database of Systematic Reviews
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|
2010, Issue 10. Art. No.: CD007574. DOI: 10.1002/14651858.CD007574.pub2. [<a href="https://pubmed.ncbi.nlm.nih.gov/20927761" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20927761</span></a>] [<a href="http://dx.crossref.org/10.1002/14651858.CD007574.pub2" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">CrossRef</a>]</div></dd></dl><dl class="bkr_refwrap"><dt>80.</dt><dd><div class="bk_ref" id="ch4.ref80">Ottomeyer
|
|
C, Zeller
|
|
J, Fesl
|
|
G, Holtmannspotter
|
|
M, Opherk
|
|
C, Bender
|
|
A
|
|
et al. Multimodal recanalization therapy in acute basilar artery occlusion: long-term functional outcome and quality of life. Stroke. 2012; 43(8):2130–5 [<a href="https://pubmed.ncbi.nlm.nih.gov/22569932" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22569932</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>81.</dt><dd><div class="bk_ref" id="ch4.ref81">Palesch
|
|
YY, Yeatts
|
|
SD, Tomsick
|
|
TA, Foster
|
|
LD, Demchuk
|
|
AM, Khatri
|
|
P
|
|
et al. Twelve-month clinical and quality-of-life outcomes in the interventional management of stroke III trial. Stroke. 2015; 46(5):1321–7 [<a href="/pmc/articles/PMC4414900/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4414900</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25858239" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25858239</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>82.</dt><dd><div class="bk_ref" id="ch4.ref82">Park
|
|
BS, Kang
|
|
CW, Kwon
|
|
HJ, Choi
|
|
SW, Kim
|
|
SH, Koh
|
|
HS
|
|
et al. Endovascular mechanical thrombectomy in basilar artery occlusion: initial experience. Journal of Cerebrovascular and Endovascular Neurosurgery. 2013; 15(3):137–44 [<a href="/pmc/articles/PMC3804649/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3804649</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24167791" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24167791</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>83.</dt><dd><div class="bk_ref" id="ch4.ref83">Phan
|
|
K, Phan
|
|
S, Huo
|
|
YR, Jia
|
|
F, Mortimer
|
|
A. Outcomes of endovascular treatment of basilar artery occlusion in the stent retriever era: a systematic review and meta-analysis. Journal of Neurointerventional Surgery. 2016; 8(11):1107–15 [<a href="https://pubmed.ncbi.nlm.nih.gov/26610730" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26610730</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>84.</dt><dd><div class="bk_ref" id="ch4.ref84">Pizzo
|
|
E, Dumba
|
|
M, Lobotesis
|
|
K. Cost-utility analysis of mechanical thrombectomy between 6 and 24 hours in acute ischemic stroke. International Journal of Stroke. 2019; Epublication [<a href="https://pubmed.ncbi.nlm.nih.gov/30758277" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30758277</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>85.</dt><dd><div class="bk_ref" id="ch4.ref85">Raychev
|
|
R, Jahan
|
|
R, Liebeskind
|
|
D, Clark
|
|
W, Nogueira
|
|
RG, Saver
|
|
J
|
|
et al. Determinants of intracranial hemorrhage occurrence and outcome after neurothrombectomy therapy: Insights from the Solitaire FR with intention for thrombectomy randomized trial. American Journal of Neuroradiology. 2015; 36(12):2303–7 [<a href="/pmc/articles/PMC7964293/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7964293</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26316567" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26316567</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>86.</dt><dd><div class="bk_ref" id="ch4.ref86">Roth
|
|
C, Mielke
|
|
A, Siekmann
|
|
R, Ferbert
|
|
A. First experiences with a new device for mechanical thrombectomy in acute basilar artery occlusion. Cerebrovascular Diseases. 2011; 32(1):28–34 [<a href="https://pubmed.ncbi.nlm.nih.gov/21576940" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21576940</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>87.</dt><dd><div class="bk_ref" id="ch4.ref87">Rouchaud
|
|
A, Mazighi
|
|
M, Labreuche
|
|
J, Meseguer
|
|
E, Serfaty
|
|
JM, Laissy
|
|
JP
|
|
et al. Outcomes of mechanical endovascular therapy for acute ischemic stroke: a clinical registry study and systematic review. Stroke. 2011; 42(5):1289–94 [<a href="https://pubmed.ncbi.nlm.nih.gov/21441143" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21441143</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>88.</dt><dd><div class="bk_ref" id="ch4.ref88">Ruggeri
|
|
M, Basile
|
|
M, Zini
|
|
A, Mangiafico
|
|
S, Agostoni
|
|
EC, Lobotesis
|
|
K
|
|
et al. Cost-effectiveness analysis of mechanical thrombectomy with stent retriever in the treatment of acute ischemic stroke in Italy. Journal of Medical Economics. 2018; 21(9):902–11 [<a href="https://pubmed.ncbi.nlm.nih.gov/29882711" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29882711</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>89.</dt><dd><div class="bk_ref" id="ch4.ref89">Sandercock
|
|
P, Berge
|
|
E, Dennis
|
|
M, Forbes
|
|
J, Hand
|
|
P, Kwan
|
|
J
|
|
et al. A systematic review of the effectiveness, cost-effectiveness and barriers to implementation of thrombolytic and neuroprotective therapy for acute ischaemic stroke in the NHS. Health Technology Assessment. 2002; 6(26) [<a href="https://pubmed.ncbi.nlm.nih.gov/12433319" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12433319</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>90.</dt><dd><div class="bk_ref" id="ch4.ref90">Saver
|
|
JL, Goyal
|
|
M, Bonafe
|
|
A, Diener
|
|
HC, Levy
|
|
EI, Pereira
|
|
VM. Solitaire™ with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) trial: protocol for a randomized, controlled, multicenter study comparing the Solitaire revascularization device with IV tPA with IV tPA alone in acute ischemic stroke. International Journal of Stroke. 2015; 10(3):439–48 [<a href="/pmc/articles/PMC4405096/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4405096</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25777831" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25777831</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>91.</dt><dd><div class="bk_ref" id="ch4.ref91">Saver
|
|
JL, Goyal
|
|
M, Bonafe
|
|
A, Diener
|
|
HC, Levy
|
|
EI, Pereira
|
|
VM
|
|
et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. New England Journal of Medicine. 2015; 372(24):2285–95 [<a href="https://pubmed.ncbi.nlm.nih.gov/25882376" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25882376</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>92.</dt><dd><div class="bk_ref" id="ch4.ref92">Saver
|
|
JL, Goyal
|
|
M, van der Lugt
|
|
A, Menon
|
|
BK, Majoie
|
|
CB, Dippel
|
|
DW
|
|
et al. Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: A meta-analysis. JAMA. 2016; 316(12):1279–88 [<a href="https://pubmed.ncbi.nlm.nih.gov/27673305" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27673305</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>93.</dt><dd><div class="bk_ref" id="ch4.ref93">Saver
|
|
JL, Jahan
|
|
R, Levy
|
|
EI, Jovin
|
|
TG, Baxter
|
|
B, Nogueira
|
|
R
|
|
et al. SOLITAIRE™ with the intention for thrombectomy (SWIFT) trial: design of a randomized, controlled, multicenter study comparing the SOLITAIRE™ Flow Restoration device and the MERCI Retriever in acute ischaemic stroke. International Journal of Stroke. 2014; 9(5):658–668 [<a href="https://pubmed.ncbi.nlm.nih.gov/23130938" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23130938</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>94.</dt><dd><div class="bk_ref" id="ch4.ref94">Saver
|
|
JL, Jahan
|
|
R, Levy
|
|
EI, Jovin
|
|
TG, Baxter
|
|
B, Nogueira
|
|
RG
|
|
et al. Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet. 2012; 380(9849):1241–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/22932715" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22932715</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>95.</dt><dd><div class="bk_ref" id="ch4.ref95">Schonewille
|
|
WJ, Wijman
|
|
CA, Michel
|
|
P, Algra
|
|
A, Kappelle
|
|
LJ, Group
|
|
BS. The Basilar Artery International Cooperation Study (BASICS). International Journal of Stroke. 2007; 2(3):220–3 [<a href="https://pubmed.ncbi.nlm.nih.gov/18705948" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18705948</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>96.</dt><dd><div class="bk_ref" id="ch4.ref96">Schonewille
|
|
WJ, Wijman
|
|
CA, Michel
|
|
P, Rueckert
|
|
CM, Weimar
|
|
C, Mattle
|
|
H
|
|
et al. Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study. Lancet Neurology. 2009; 8(8):724–730 [<a href="https://pubmed.ncbi.nlm.nih.gov/19577962" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19577962</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>97.</dt><dd><div class="bk_ref" id="ch4.ref97">Sherman
|
|
DG, Atkinson
|
|
RP, Chippendale
|
|
T, Levin
|
|
KA, Ng
|
|
K, Futrell
|
|
N
|
|
et al. Intravenous ancrod for treatment of acute ischemic stroke: the STAT study: a randomized controlled trial. Stroke Treatment with Ancrod Trial. JAMA. 2000; 283(18):2395–403 [<a href="https://pubmed.ncbi.nlm.nih.gov/10815082" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10815082</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>98.</dt><dd><div class="bk_ref" id="ch4.ref98">Sheth
|
|
SA, Jahan
|
|
R, Gralla
|
|
J, Pereira
|
|
VM, Nogueira
|
|
RG, Levy
|
|
EI
|
|
et al. Time to endovascular reperfusion and degree of disability in acute stroke. Annals of Neurology. 2015; 78(4):584–93 [<a href="/pmc/articles/PMC4955570/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4955570</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26153450" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26153450</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>99.</dt><dd><div class="bk_ref" id="ch4.ref99">Sheth
|
|
SA, Jahan
|
|
R, Levy
|
|
EI, Jovin
|
|
TG, Baxter
|
|
B, Nogueira
|
|
RG
|
|
et al. Rapid learning curve for Solitaire FR stent retriever therapy: evidence from roll-in and randomised patients in the SWIFT trial. Journal of Neurointerventional Surgery. 2016; 8(4):347–52 [<a href="/pmc/articles/PMC4955564/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4955564</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25676147" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25676147</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>100.</dt><dd><div class="bk_ref" id="ch4.ref100">Shi
|
|
ZS, Loh
|
|
Y, Walker
|
|
G, Duckwiler
|
|
GR, Merci, Multi
|
|
MI. Endovascular thrombectomy for acute ischemic stroke in failed intravenous tissue plasminogen activator versus non-intravenous tissue plasminogen activator patients: revascularization and outcomes stratified by the site of arterial occlusions. Stroke. 2010; 41(6):1185–92 [<a href="https://pubmed.ncbi.nlm.nih.gov/20431084" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20431084</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>101.</dt><dd><div class="bk_ref" id="ch4.ref101">Singer
|
|
OC, Berkefeld
|
|
J, Nolte
|
|
CH, Bohner
|
|
G, Haring
|
|
HP, Trenkler
|
|
J
|
|
et al. Mechanical recanalization in basilar artery occlusion: the ENDOSTROKE study. Annals of Neurology. 2015; 77(3):415–24 [<a href="https://pubmed.ncbi.nlm.nih.gov/25516154" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25516154</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>102.</dt><dd><div class="bk_ref" id="ch4.ref102">Singer
|
|
OC, Haring
|
|
HP, Trenkler
|
|
J, Nolte
|
|
CH, Bohner
|
|
G, Neumann-Haefelin
|
|
T
|
|
et al. Periprocedural aspects in mechanical recanalization for acute stroke: data from the ENDOSTROKE registry. Neuroradiology. 2013; 55(9):1143–51 [<a href="https://pubmed.ncbi.nlm.nih.gov/23811957" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23811957</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>103.</dt><dd><div class="bk_ref" id="ch4.ref103">Smith
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|
WS, Yan
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|
B. REVASCAT Trial: Further advancement in endovascular stroke therapy. Stroke. 2015; 46(10):3012–3 [<a href="https://pubmed.ncbi.nlm.nih.gov/26337972" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26337972</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>104.</dt><dd><div class="bk_ref" id="ch4.ref104">Steen Carlsson
|
|
K, Andsberg
|
|
G, Petersson
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|
J, Norrving
|
|
B. Long-term cost-effectiveness of thrombectomy for acute ischaemic stroke in real life: An analysis based on data from the Swedish Stroke Register (Riksstroke). International Journal of Stroke. 2017; 12(8):802–814 [<a href="https://pubmed.ncbi.nlm.nih.gov/28375069" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28375069</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>105.</dt><dd><div class="bk_ref" id="ch4.ref105">Tian
|
|
Z, Liao
|
|
G, Li
|
|
S, Shen
|
|
Y, Chen
|
|
C, Liu
|
|
L
|
|
et al. Comparison of multimodal intra-arterial treatment versus intravenous thrombolysis for hypertensive patients with severe large vessel cerebral infarction. Journal of Investigative Medicine. 2017; 65(7):1033–40 [<a href="https://pubmed.ncbi.nlm.nih.gov/28735256" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28735256</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>106.</dt><dd><div class="bk_ref" id="ch4.ref106">Touma
|
|
L, Filion
|
|
KB, Sterling
|
|
LH, Atallah
|
|
R, Windle
|
|
SB, Eisenberg
|
|
MJ. Stent retrievers for the treatment of acute ischemic stroke: A systematic review and meta-analysis of randomized clinical trials. JAMA Neurology. 2016; 73(3):275–81 [<a href="https://pubmed.ncbi.nlm.nih.gov/26810499" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26810499</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>107.</dt><dd><div class="bk_ref" id="ch4.ref107">Trippoli
|
|
S, Caccese
|
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E, Marinai
|
|
C, Messori
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|
A. Value-based procurement of medical devices: Application to devices for mechanical thrombectomy in ischemic stroke. Clinical Neurology and Neurosurgery. 2018; 166:61–5 [<a href="https://pubmed.ncbi.nlm.nih.gov/29408775" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29408775</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>108.</dt><dd><div class="bk_ref" id="ch4.ref108">von Kummer
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|
R. Do patients with acute vertebrobasilar occlusion benefit from an aggressive treatment strategy?
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Nature Clinical Practice Cardiovascular Medicine. 2005; 2(11):564–5 [<a href="https://pubmed.ncbi.nlm.nih.gov/16258566" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16258566</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>109.</dt><dd><div class="bk_ref" id="ch4.ref109">Webb
|
|
S, Yashar
|
|
P, Kan
|
|
P, Siddiqui
|
|
AH, Hopkins
|
|
LN, Levy
|
|
EI. Treatment and outcomes of acute intracranial vertebrobasilar artery occlusion: one institution’s experience. Journal of Neurosurgery. 2012; 116(5):952–60 [<a href="https://pubmed.ncbi.nlm.nih.gov/22304447" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22304447</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>110.</dt><dd><div class="bk_ref" id="ch4.ref110">Wen
|
|
WL, Li
|
|
ZF, Zhang
|
|
YW, Yang
|
|
PF, Simfukwe
|
|
K, Fang
|
|
YB
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|
et al. Effect of baseline characteristics on the outcome of stent retriever-based thrombectomy in acute basilar artery occlusions: A single-center experience and pooled data analysis. World Neurosurgery. 2017; 104:1–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/28427984" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28427984</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>111.</dt><dd><div class="bk_ref" id="ch4.ref111">Wyszomirski
|
|
A, Szczyrba
|
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S, Tomaka
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|
D, Karaszewski
|
|
B. Treatment of acute basilar artery occlusion: Systematic review and meta-analysis. Neurologia i Neurochirurgia Polska. 2017; 51(6):486–96 [<a href="https://pubmed.ncbi.nlm.nih.gov/28823413" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28823413</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>112.</dt><dd><div class="bk_ref" id="ch4.ref112">Xianxian
|
|
Z, Chengsong
|
|
Y, Qiang
|
|
M, Fei
|
|
W, Lin
|
|
S, Huiyan
|
|
D
|
|
et al. The efficiency analysis of thrombolytic rt-PA combined with intravascular interventional therapy in patients with acute basilar artery occlusion. International Journal of Biological Sciences. 2017; 13(1):57–64 [<a href="/pmc/articles/PMC5264261/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5264261</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28123346" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28123346</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>113.</dt><dd><div class="bk_ref" id="ch4.ref113">Xie
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X, Lambrinos
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A, Chan
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B, Dhalla
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IA, Krings
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T, Casaubon
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LK
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et al. Mechanical thrombectomy in patients with acute ischemic stroke: a cost-utility analysis. CMAJ Open. 2016; 4(2):E316–25 [<a href="/pmc/articles/PMC4933608/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4933608</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27398380" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27398380</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>114.</dt><dd><div class="bk_ref" id="ch4.ref114">Yang
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D, Hao
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Y, Zi
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W, Wang
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H, Zheng
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D, Li
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H
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et al. Effect of retrievable stent size on endovascular treatment of acute ischemic stroke: a multicenter study. American Journal of Neuroradiology. 2017; 38(8):1586–93 [<a href="/pmc/articles/PMC7960417/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7960417</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28596196" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28596196</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>115.</dt><dd><div class="bk_ref" id="ch4.ref115">Yang
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Y, Liang
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C, Shen
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C, Tang
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H, Ma
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S, Zhang
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Q
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et al. The effects of pharmaceutical thrombolysis and multi-modal therapy on patients with acute posterior circulation ischemic stroke: Results of a one center retrospective study. International Journal Of Surgery. 2017; 39:197–201 [<a href="https://pubmed.ncbi.nlm.nih.gov/28185942" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28185942</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>116.</dt><dd><div class="bk_ref" id="ch4.ref116">Yoshimura
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S, Egashira
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Y, Sakai
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N, Kuwayama
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N, Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism-Japan retrospective survey group. Retrospective nationwide survey of acute stroke due to large vessel occlusion in Japan: a review of 1,963 patients and the impact of endovascular treatment. Cerebrovascular Diseases. 2011; 32(3):219–26 [<a href="https://pubmed.ncbi.nlm.nih.gov/21860234" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21860234</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>117.</dt><dd><div class="bk_ref" id="ch4.ref117">Yoshimura
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S, Sakai
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N, Okada
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Y, Kitagawa
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K, Kimura
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K, Tanahashi
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N
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et al. Efficacy of endovascular treatment for acute cerebral large-vessel occlusion: analysis of nationwide prospective registry. Journal of Stroke and Cerebrovascular Diseases. 2014; 23(5):1183–90 [<a href="https://pubmed.ncbi.nlm.nih.gov/24424332" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24424332</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>118.</dt><dd><div class="bk_ref" id="ch4.ref118">Zaidat
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OO, Castonguay
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AC, Nogueira
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RG, Haussen
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DC, English
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JD, Satti
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SR
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et al. TREVO stent-retriever mechanical thrombectomy for acute ischemic stroke secondary to large vessel occlusion registry. Journal of Neurointerventional Surgery. 2018; 10:516–24 [<a href="/pmc/articles/PMC5969387/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5969387</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28963367" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28963367</span></a>]</div></dd></dl></dl></div><div id="appendixesappgroup4"><h2 id="_appendixesappgroup4_">Appendices</h2><div id="ch4.appa"><h3>Appendix A. Review protocols</h3><p id="ch4.appa.tab1"><a href="/books/NBK577865/table/ch4.appa.tab1/?report=objectonly" target="object" rid-ob="figobch4appatab1" class="figpopup">Table 10. Review protocol: thrombectomy</a></p><p id="ch4.appa.tab2"><a href="/books/NBK577865/table/ch4.appa.tab2/?report=objectonly" target="object" rid-ob="figobch4appatab2" class="figpopup">Table 11. Health economic review protocol</a></p></div><div id="ch4.appb"><h3>Appendix B. Literature search strategies</h3><p>The literature searches for this review are detailed below and complied with the methodology outlined in Developing NICE guidelines: the manual 2014, updated 2017 <a href="https://www.nice.org.uk/guidance/pmg20/resources/developing-nice-guidelines-the-manual-pdf-72286708700869" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.nice.org.uk/guidance/pmg20/resources/developing-nice-guidelines-the-manual-pdf-72286708700869</a></p><p><i>For more detailed information, please see the</i> Methodology <i>Review</i>.</p><div id="ch4.appb.s1"><h4>B.1. Clinical search literature search strategy</h4><p>Searches were constructed using a PICO framework where population (P) terms were combined with Intervention (I) and in some cases Comparison (C) terms. Outcomes (O) are rarely used in search strategies for interventions as these concepts may not be well described in title, abstract or indexes and therefore difficult to retrieve. Search filters were applied to the search where appropriate.</p><p id="ch4.appb.tab1"><a href="/books/NBK577865/table/ch4.appb.tab1/?report=objectonly" target="object" rid-ob="figobch4appbtab1" class="figpopup">Table 12. Database date parameters and filters used</a></p><p id="ch4.appb.tab2"><a href="/books/NBK577865/table/ch4.appb.tab2/?report=objectonly" target="object" rid-ob="figobch4appbtab2" class="figpopup">Medline (Ovid) search terms</a></p><p id="ch4.appb.tab3"><a href="/books/NBK577865/table/ch4.appb.tab3/?report=objectonly" target="object" rid-ob="figobch4appbtab3" class="figpopup">Embase (Ovid) search terms</a></p><p id="ch4.appb.tab4"><a href="/books/NBK577865/table/ch4.appb.tab4/?report=objectonly" target="object" rid-ob="figobch4appbtab4" class="figpopup">Cochrane Library (Wiley) search terms</a></p></div><div id="ch4.appb.s2"><h4>B.2. Health Economics literature search strategy</h4><p>Health economic evidence was identified by conducting a broad search relating to the stroke population in NHS Economic Evaluation Database (NHS EED – this ceased to be updated after March 2015) and the Health Technology Assessment database (HTA) with no date restrictions. NHS EED and HTA databases are hosted by the Centre for Research and Dissemination (CRD). Additional searches were run on Medline and Embase for health economics.</p><p id="ch4.appb.tab5"><a href="/books/NBK577865/table/ch4.appb.tab5/?report=objectonly" target="object" rid-ob="figobch4appbtab5" class="figpopup">Table 13. Database date parameters and filters used</a></p><p id="ch4.appb.tab6"><a href="/books/NBK577865/table/ch4.appb.tab6/?report=objectonly" target="object" rid-ob="figobch4appbtab6" class="figpopup">Medline (Ovid) search terms</a></p><p id="ch4.appb.tab7"><a href="/books/NBK577865/table/ch4.appb.tab7/?report=objectonly" target="object" rid-ob="figobch4appbtab7" class="figpopup">Embase (Ovid) search terms</a></p><p id="ch4.appb.tab8"><a href="/books/NBK577865/table/ch4.appb.tab8/?report=objectonly" target="object" rid-ob="figobch4appbtab8" class="figpopup">NHS EED and HTA (CRD) search terms</a></p></div></div><div id="ch4.appc"><h3>Appendix C. Clinical evidence selection</h3><p id="ch4.appc.fig1"><a href="/books/NBK577865/figure/ch4.appc.fig1/?report=objectonly" target="object" rid-ob="figobch4appcfig1" class="figpopup">Figure 1. Flow chart of clinical study selection for the review of thrombectomy for anterior circulation stroke</a></p><p id="ch4.appc.fig2"><a href="/books/NBK577865/figure/ch4.appc.fig2/?report=objectonly" target="object" rid-ob="figobch4appcfig2" class="figpopup">Figure 2. Flow chart of clinical study selection for the additional search on thrombectomy for posterior circulatory stroke</a></p></div><div id="ch4.appd"><h3>Appendix D. Clinical evidence tables</h3><div id="ch4.appd.s1"><h4>D.1. Anterior circulation stroke (randomised studies)</h4><p id="ch4.appd.et1"><a href="/books/NBK577865/bin/ch4-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (444K)</span></p></div><div id="ch4.appd.s2"><h4>D2. Posterior circulation stroke (observational studies)</h4><p>No studies were identified</p></div></div><div id="ch4.appe"><h3>Appendix E. Forest plots and ordinal shift graphs</h3><div id="ch4.appe.s1"><h4>E.1. Anterior circulation stroke</h4><div id="ch4.appe.s1.1"><h5>E.1.1. Thrombectomy versus thrombolysis or best medical practice</h5><p id="ch4.appe.fig1"><a href="/books/NBK577865/figure/ch4.appe.fig1/?report=objectonly" target="object" rid-ob="figobch4appefig1" class="figpopup">Figure 3. Mortality at 90 days</a></p><p id="ch4.appe.fig2"><a href="/books/NBK577865/figure/ch4.appe.fig2/?report=objectonly" target="object" rid-ob="figobch4appefig2" class="figpopup">Figure 4. Mortality at 90 days</a></p><p id="ch4.appe.fig3"><a href="/books/NBK577865/figure/ch4.appe.fig3/?report=objectonly" target="object" rid-ob="figobch4appefig3" class="figpopup">Figure 5. Mortality at 1 year (thrombectomy up to 8 hours)</a></p><p id="ch4.appe.fig4"><a href="/books/NBK577865/figure/ch4.appe.fig4/?report=objectonly" target="object" rid-ob="figobch4appefig4" class="figpopup">Figure 6. Modified Rankin Scale (0 - 2) at 90 days</a></p><p id="ch4.appe.fig5"><a href="/books/NBK577865/figure/ch4.appe.fig5/?report=objectonly" target="object" rid-ob="figobch4appefig5" class="figpopup">Figure 7. Modified Rankin Scale (0 - 2) at 1 year (thrombectomy up to 8 hours)</a></p><p id="ch4.appe.fig6"><a href="/books/NBK577865/figure/ch4.appe.fig6/?report=objectonly" target="object" rid-ob="figobch4appefig6" class="figpopup">Figure 8. Modified Rankin Scale at 90 days (ordinal shift common odds ratios)</a></p><p id="ch4.appe.fig7"><a href="/books/NBK577865/figure/ch4.appe.fig7/?report=objectonly" target="object" rid-ob="figobch4appefig7" class="figpopup">Figure 9. Modified Rankin Scale at 90 days (ordinal shift graphs)</a></p><p id="ch4.appe.fig8"><a href="/books/NBK577865/figure/ch4.appe.fig8/?report=objectonly" target="object" rid-ob="figobch4appefig8" class="figpopup">Figure 10. Modified Rankin Scale at 1 year (thrombectomy up to 8 hours)</a></p><p id="ch4.appe.fig9"><a href="/books/NBK577865/figure/ch4.appe.fig9/?report=objectonly" target="object" rid-ob="figobch4appefig9" class="figpopup">Figure 11. Symptomatic intracranial haemorrhage at 90 days</a></p><p id="ch4.appe.fig10"><a href="/books/NBK577865/figure/ch4.appe.fig10/?report=objectonly" target="object" rid-ob="figobch4appefig10" class="figpopup">Figure 12. Intracerebral haemorrhage at 90 days (thrombectomy up to 6 hours)</a></p><p id="ch4.appe.fig11"><a href="/books/NBK577865/figure/ch4.appe.fig11/?report=objectonly" target="object" rid-ob="figobch4appefig11" class="figpopup">Figure 13. Recurrent stroke at 90 days (thrombectomy up to 8 hours)</a></p><p id="ch4.appe.fig12"><a href="/books/NBK577865/figure/ch4.appe.fig12/?report=objectonly" target="object" rid-ob="figobch4appefig12" class="figpopup">Figure 14. Malignant middle cerebral artery syndrome at 90 days (thrombectomy up to 12 hours)</a></p><p id="ch4.appe.fig13"><a href="/books/NBK577865/figure/ch4.appe.fig13/?report=objectonly" target="object" rid-ob="figobch4appefig13" class="figpopup">Figure 15. Any serious adverse event at 90 days (thrombectomy up to 6 hours)</a></p><p id="ch4.appe.fig14"><a href="/books/NBK577865/figure/ch4.appe.fig14/?report=objectonly" target="object" rid-ob="figobch4appefig14" class="figpopup">Figure 16. Procedural complications (thrombectomy 6-24 hours)</a></p><p id="ch4.appe.fig15"><a href="/books/NBK577865/figure/ch4.appe.fig15/?report=objectonly" target="object" rid-ob="figobch4appefig15" class="figpopup">Figure 17. EQ-5D at 90 days (thrombectomy up to 6 hours)</a></p></div></div><div id="ch4.appe.s2"><h4>E.2. Posterior circulation stroke</h4><p>No studies were identified</p></div></div><div id="ch4.appf"><h3>Appendix F. GRADE tables</h3><div id="ch4.appf.s1"><h4>F.1. Thrombectomy within 6 hours with or without alteplase versus alteplase or standard medical care</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch4appftab1"><a href="/books/NBK577865/table/ch4.appf.tab1/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figch4appftab1" rid-ob="figobch4appftab1"><img class="small-thumb" src="/books/NBK577865/table/ch4.appf.tab1/?report=thumb" src-large="/books/NBK577865/table/ch4.appf.tab1/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="ch4.appf.tab1"><a href="/books/NBK577865/table/ch4.appf.tab1/?report=objectonly" target="object" rid-ob="figobch4appftab1">Table</a></h4><p class="float-caption no_bottom_margin">93/650 (14.3%)</p></div></div></div><div id="ch4.appf.s2"><h4>F.2. Thrombectomy within 8 hours with or without alteplase versus alteplase or standard medical care</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch4appftab2"><a href="/books/NBK577865/table/ch4.appf.tab2/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figch4appftab2" rid-ob="figobch4appftab2"><img class="small-thumb" src="/books/NBK577865/table/ch4.appf.tab2/?report=thumb" src-large="/books/NBK577865/table/ch4.appf.tab2/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="ch4.appf.tab2"><a href="/books/NBK577865/table/ch4.appf.tab2/?report=objectonly" target="object" rid-ob="figobch4appftab2">Table</a></h4><p class="float-caption no_bottom_margin">19/103 (18.4%)</p></div></div></div><div id="ch4.appf.s3"><h4>F.3. Thrombectomy within 12 hours with or without alteplase versus alteplase or standard medical care</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch4appftab3"><a href="/books/NBK577865/table/ch4.appf.tab3/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figch4appftab3" rid-ob="figobch4appftab3"><img class="small-thumb" src="/books/NBK577865/table/ch4.appf.tab3/?report=thumb" src-large="/books/NBK577865/table/ch4.appf.tab3/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="ch4.appf.tab3"><a href="/books/NBK577865/table/ch4.appf.tab3/?report=objectonly" target="object" rid-ob="figobch4appftab3">Table</a></h4><p class="float-caption no_bottom_margin">17/164 (10.4%)</p></div></div></div><div id="ch4.appf.s4"><h4>F.4. Thrombectomy between 6 - 24 hours onset of s<u>ymptoms versus standard medical c</u>are</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch4appftab4"><a href="/books/NBK577865/table/ch4.appf.tab4/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figch4appftab4" rid-ob="figobch4appftab4"><img class="small-thumb" src="/books/NBK577865/table/ch4.appf.tab4/?report=thumb" src-large="/books/NBK577865/table/ch4.appf.tab4/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="ch4.appf.tab4"><a href="/books/NBK577865/table/ch4.appf.tab4/?report=objectonly" target="object" rid-ob="figobch4appftab4">Table</a></h4><p class="float-caption no_bottom_margin">33/199 (16.6%)</p></div></div></div></div><div id="ch4.appg"><h3>Appendix G. Health economic evidence selection</h3><p id="ch4.appg.fig1"><a href="/books/NBK577865/figure/ch4.appg.fig1/?report=objectonly" target="object" rid-ob="figobch4appgfig1" class="figpopup">Figure 18. Flow chart of health economic study selection for the guideline</a></p></div><div id="ch4.apph"><h3>Appendix H. Excluded studies</h3><div id="ch4.apph.s1"><h4>H.1. Excluded clinical studies</h4><p id="ch4.apph.tab1"><a href="/books/NBK577865/table/ch4.apph.tab1/?report=objectonly" target="object" rid-ob="figobch4apphtab1" class="figpopup">Table 14. Studies excluded from the clinical review</a></p></div><div id="ch4.apph.s2"><h4>H.2. Excluded health economic studies</h4><p>Published health economic studies that met the inclusion criteria (relevant population, comparators, economic study design, published 2002 or later and not from non-OECD country or USA) but that were excluded following appraisal of applicability and methodological quality are listed below. See the health economic protocol for more details.</p><p id="ch4.apph.tab2"><a href="/books/NBK577865/table/ch4.apph.tab2/?report=objectonly" target="object" rid-ob="figobch4apphtab2" class="figpopup">Table 15. Studies excluded from the health economic review</a></p></div></div><div id="ch4.appi"><h3>Appendix I. Health economic evidence tables</h3><p id="ch4.appi.et1"><a href="/books/NBK577865/bin/ch4-appi-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (242K)</span></p></div></div><div><h2 id="NBK577865_footnotes">Footnotes</h2><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="ch4.fn1"><p class="no_top_margin">McMeekin P, White P, James MA, Price CI, Flynn D, Ford GA. Estimating the number of UK stroke patients eligible for endovascular thrombectomy. 2017; 2(4): 319-326</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="ch4.fn2"><p class="no_top_margin">Jadhav AP, Desai, SM, Kenmuir CL, Rocha M, Starr MT, et al. Eligibiilty for endovascular trial enrolment in the 6- to 24-hour time window: analysis of a single comprehensive stroke center. 2018; 49(4): 1015-1017</p></div></dd></dl></dl></div></div><div class="fm-sec"><div><p>FINAL</p></div><div><p>Intervention evidence review</p><p>This evidence review was developed by the National Guideline Centre</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2019.</div><div class="small"><span class="label">Bookshelf ID: NBK577865</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/35167204" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">35167204</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobch4tab1"><div id="ch4.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">PICO characteristics of review question</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577865/table/ch4.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch4.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_ch4.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_ch4.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">People aged over 16 with acute ischaemic stroke, with a proven large vessel occlusion on non-invasive angiography.</td></tr><tr><th id="hd_b_ch4.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention(s)</th><td headers="hd_b_ch4.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Endovascular therapy (mechanical thrombectomy) with or without alteplase</td></tr><tr><th id="hd_b_ch4.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison(s)</th><td headers="hd_b_ch4.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intravenous thrombolysis (alteplase) or standard care (for example, aspirin)</td></tr><tr><th id="hd_b_ch4.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_ch4.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<u>Critical</u>
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<p>Modified Rankin scale (mRS) 0 – 2 or ordinal shift, 90 days and 1 year</p>
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<p>Mortality at 90 days and 1 year</p>
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<u>Important</u>
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<p>Intracerebral haemorrhage</p>
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<p>Symptomatic intracerebral haemorrhage</p>
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<p>Patient reported outcome measures</p>
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<p>Quality of life (both health- and social-related quality)</p>
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<p>Length of stay in hospital</p>
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<p>Procedural complications</p>
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</td></tr><tr><th id="hd_b_ch4.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_ch4.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Randomised controlled trials</p>
|
|
<p>Systematic reviews and meta-analyses of the above</p>
|
|
<p>Observational studies with multivariable analysis if no RCTs are identified</p>
|
|
</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch4tab2"><div id="ch4.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of studies included in the evidence review for anterior circulation stroke</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577865/table/ch4.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch4.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_ch4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Intervention and comparison</th><th id="hd_h_ch4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Population</th><th id="hd_h_ch4.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_ch4.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Comments</th></tr></thead><tbody><tr><th headers="hd_h_ch4.tab2_1_1_1_1 hd_h_ch4.tab2_1_1_1_2 hd_h_ch4.tab2_1_1_1_3 hd_h_ch4.tab2_1_1_1_4 hd_h_ch4.tab2_1_1_1_5" id="hd_b_ch4.tab2_1_1_1_1" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">Thrombectomy within 6 hours of stroke onset</th></tr><tr><td headers="hd_h_ch4.tab2_1_1_1_1 hd_b_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Berkhemer 2015<a class="bibr" href="#ch4.ref15" rid="ch4.ref15"><sup>15</sup></a><sup>,</sup>
|
|
<a class="bibr" href="#ch4.ref37" rid="ch4.ref37"><sup>37</sup></a></p>
|
|
<p>MR CLEAN</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_2 hd_b_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Intra-arterial thrombolysis (urokinase or alteplase), mechanical thrombectomy (within 6 hours) or both vs best medical practice</p>
|
|
<p>Median (IQR) time from onset to alteplase: intervention 85 (67110); control 87 (65-116) minutes IV alteplase = 87.1% intervention, 90.6% control</p>
|
|
<p>Additional intra-arterial thrombolytics used in 10.3% and intraarterial thrombolytics as monotherapy in 0.4%</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_3 hd_b_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>n = 500</p>
|
|
<p>Netherlands</p>
|
|
<p>Age ≥18</p>
|
|
<p>Mean age (range) = 65 (23 - 96)</p>
|
|
<p>Patient selection criteria: evidence of occlusion on CTA, MRA or DSA; enrolment not limited according to ASPECTS or extension of early signs of infarction at baseline</p>
|
|
<p>Median (IQR) NIHSS:</p>
|
|
<p>Intervention = 17 (14-21)</p>
|
|
<p>Control = 18 (14-22)</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_4 hd_b_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Mortality at 90 days</p>
|
|
<p>mRS at 90 days</p>
|
|
<p>Symptomatic intracerebral haemorrhage</p>
|
|
<p>Stroke at 90 days</p>
|
|
<p>EQ-5D at 90 days</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_5 hd_b_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Of the intervention group 83.7% received thrombectomy; 15.9% received no intra-arterial intervention; 0.4% received intra-arterial thrombolysis alone</p>
|
|
<p>Funded by industry</p>
|
|
</td></tr><tr><td headers="hd_h_ch4.tab2_1_1_1_1 hd_b_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Bracard 2016<a class="bibr" href="#ch4.ref17" rid="ch4.ref17"><sup>17</sup></a></p>
|
|
<p>THRACE</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_2 hd_b_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Thrombectomy (within 5 hours) plus IV alteplase vs IV alteplase</p>
|
|
<p>All received IV alteplase</p>
|
|
<p>Median (IQR) time from stroke onset to IV thrombolysis: intervention 150 (120-178) minutes</p>
|
|
<p>Control 153 (124-180) minutes</p>
|
|
<p>Median (IQR) time from stroke onset to thrombectomy: 250 (210-290) minutes</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_3 hd_b_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>n = 414</p>
|
|
<p>26 centres in France</p>
|
|
<p>Age 18 - 80</p>
|
|
<p>Median (IQR) intervention = 66 (54 - 74) control = 68 (54 - 75)</p>
|
|
<p>Patient selection criteria: evidence of occlusion on CTA or MRA</p>
|
|
<p>Median (IQR) NIHSS:</p>
|
|
<p>Intervention = 18 (15-21)</p>
|
|
<p>Control = 17 (13-20)</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_4 hd_b_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Mortality at 90 days</p>
|
|
<p>mRS at 90 days</p>
|
|
<p>EQ-5D</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_5 hd_b_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Funded by academia/government</td></tr><tr><td headers="hd_h_ch4.tab2_1_1_1_1 hd_b_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Campbell 2015<a class="bibr" href="#ch4.ref21" rid="ch4.ref21"><sup>21</sup></a></p>
|
|
<p>EXTEND IA</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_2 hd_b_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Mechanical thrombectomy (within 6 hours) plus IV alteplase vs IV alteplase</p>
|
|
<p>All received thrombolysis</p>
|
|
<p>Median (IQR) time from onset to alteplase: intervention 127 (93-162); control 145 (105-180) minutes</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_3 hd_b_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>n = 70</p>
|
|
<p>10 study centres across Australia and New Zealand</p>
|
|
<p>Age ≥18</p>
|
|
<p>Mean age (SD) intervention = 68.6 (12.3) control = 70.2 (11.8)</p>
|
|
<p>Patient selection criteria: evidence of occlusion on CTA</p>
|
|
<p>Median (IQR) NIHSS:</p>
|
|
<p>Intervention = 17 (13-20)</p>
|
|
<p>Control = 13 (9-19)</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_4 hd_b_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Mortality at 90 days</p>
|
|
<p>mRS at 90 days</p>
|
|
<p>Symptomatic intracerebral haemorrhage</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_5 hd_b_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Used CT perfusion imaging to select patients likely to benefit</p>
|
|
<p>Trial stopped early because of efficacy.</p>
|
|
<p>Funded by industry and academia</p>
|
|
</td></tr><tr><td headers="hd_h_ch4.tab2_1_1_1_1 hd_b_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Saver 2015<a class="bibr" href="#ch4.ref90" rid="ch4.ref90"><sup>90</sup></a><sup>,</sup>
|
|
<a class="bibr" href="#ch4.ref91" rid="ch4.ref91"><sup>91</sup></a></p>
|
|
<p>SWIFT PRIME</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_2 hd_b_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Mechanical thrombectomy (within 6 hours) plus IV thrombolysis (tPA) vs IV thrombolysis (tPA)</p>
|
|
<p>All received thrombolysis</p>
|
|
<p>Median (IQR) time from onset to randomisation: intervention 190.5 (141-249); control 188 (130-268) minutes</p>
|
|
<p>Median (IQR) time from stroke onset to groin puncture: 224 (165-275) minutes</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_3 hd_b_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>n = 196</p>
|
|
<p>39 centres in USA and Europe.</p>
|
|
<p>Age 18 - 80</p>
|
|
<p>Mean age (SD) intervention = 65 (12.5) control = 66.3 (11.3)</p>
|
|
<p>Patient selection criteria: initially used a ‘target mismatch’ strategy, using multimodal CT or MRI, including perfusion sequences, to identify patients with salvageable tissue. Subsequently, a ‘small to moderate core’ strategy, using ASPECTS ratings of CT or MRI was used.</p>
|
|
<p>Median (IQR) NIHSS:</p>
|
|
<p>Intervention = 17 (13-19)</p>
|
|
<p>Control = 17 (13-20)</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_4 hd_b_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Mortality at 90 days</p>
|
|
<p>mRS at 90 days</p>
|
|
<p>Symptomatic intracerebral haemorrhage</p>
|
|
<p>Procedural complications</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_5 hd_b_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Study stopped due to interim analysis showed evidence of efficacy</p>
|
|
<p>Funded by industry.</p>
|
|
</td></tr><tr><td headers="hd_h_ch4.tab2_1_1_1_1 hd_b_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Mocco 2016<a class="bibr" href="#ch4.ref66" rid="ch4.ref66"><sup>66</sup></a></p>
|
|
<p>THERAPY</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_2 hd_b_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Thrombectomy (within 6 hours) plus alteplasevs IV alteplase</p>
|
|
<p>All received IV alteplase</p>
|
|
<p>Median (IQR) time from onset to groin puncture in intervention group: 227 (184-262) minutes</p>
|
|
<p>Median time from onset to IV alteplase, intervention: 108 (86-138) and control: 102 (80-154) minutes</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_3 hd_b_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>n = 108</p>
|
|
<p>36 USA and German centres</p>
|
|
<p>18 to 85 years of age</p>
|
|
<p>Mean age (SD): Intervention = 67 (11) Control = 70 (10).</p>
|
|
<p>Patient selection criteria: evidence of occlusion on CTA</p>
|
|
<p>Median (IQR) NIHSS:</p>
|
|
<p>Intervention = 17 (13-22)</p>
|
|
<p>Control = 18 (14-22)</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_4 hd_b_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Mortality at 90 days</p>
|
|
<p>mRS at 90 days</p>
|
|
<p>Symptomatic intracerebral haemorrhage</p>
|
|
<p>Serious adverse events</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_5 hd_b_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Trial enrolment was halted after the presentation of the MR CLEAN study at the World Stroke Congress</td></tr><tr><td headers="hd_h_ch4.tab2_1_1_1_1 hd_b_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Muir 2017<a class="bibr" href="#ch4.ref71" rid="ch4.ref71"><sup>71</sup></a></p>
|
|
<p>PISTE</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_2 hd_b_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Mechanical thrombectomy (within 6 hours) plus IV thrombolysis vs IV thrombolysis</p>
|
|
<p>All received thrombolysis</p>
|
|
<p>Median time from onset to IV alteplase, intervention: 120 (61-242) and control: 120 (62-238) minutes</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_3 hd_b_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>n = 65</p>
|
|
<p>10 centres in the UK</p>
|
|
<p>Age ≥18</p>
|
|
<p>Mean age (SD) intervention = 67 (17) control = 64 (16)</p>
|
|
<p>Patient selection criteria: evidence of occlusion on CTA or MRA</p>
|
|
<p>Median (IQR) NIHSS:</p>
|
|
<p>Intervention = 18 (6-24)</p>
|
|
<p>Control = 14 (6-29)
|
|
</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_4 hd_b_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Mortality at 90 days</p>
|
|
<p>Fatal/serious adverse events at 90 days</p>
|
|
<p>mRS at 90 days</p>
|
|
<p>Symptomatic intracerebral haemorrhage</p>
|
|
<p>Intracerebral haemorrhage</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_5 hd_b_ch4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Trial recruitment suspended following other thrombectomy trial results</p>
|
|
<p>Funded by industry and academia</p>
|
|
</td></tr><tr><th headers="hd_h_ch4.tab2_1_1_1_1 hd_h_ch4.tab2_1_1_1_2 hd_h_ch4.tab2_1_1_1_3 hd_h_ch4.tab2_1_1_1_4 hd_h_ch4.tab2_1_1_1_5" id="hd_b_ch4.tab2_1_1_8_1" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">Thrombectomy within 8 hours of stroke onset</th></tr><tr><td headers="hd_h_ch4.tab2_1_1_1_1 hd_b_ch4.tab2_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Jovin 2015<a class="bibr" href="#ch4.ref28" rid="ch4.ref28"><sup>28</sup></a><sup>,</sup>
|
|
<a class="bibr" href="#ch4.ref51" rid="ch4.ref51"><sup>51</sup></a><sup>,</sup>
|
|
<a class="bibr" href="#ch4.ref67" rid="ch4.ref67"><sup>67</sup></a></p>
|
|
<p>REVASCAT</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_2 hd_b_ch4.tab2_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Thrombectomy (within 8 hours) plus standard medical management including IV alteplase when eligible vs standard medical management: including IV alteplase when eligible</p>
|
|
<p>IV alteplase: intervention 70/103 (68.0%); control 80/103 (77.7%)</p>
|
|
<p>Median (IQR) time from onset to IV thrombolysis: intervention 117.5 (90-150); control 105 (86-137.5) minutes</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_3 hd_b_ch4.tab2_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>N = 206</p>
|
|
<p>4 centres in Spain</p>
|
|
<p>Age 18 - 80</p>
|
|
<p>Mean age (SD) intervention = 65.7 (11.3) control = 67.2 (9.5)</p>
|
|
<p>Median (IQR) NIHSS:</p>
|
|
<p>Intervention = 17 (14-20)</p>
|
|
<p>Control = 17 (12-19)</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_4 hd_b_ch4.tab2_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Mortality at 90 days</p>
|
|
<p>mRS at 90 days</p>
|
|
<p>Symptomatic intracranial haemorrhage</p>
|
|
<p>Stroke at 90 days EQ-5D</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_5 hd_b_ch4.tab2_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Recruitment stopped due to emerging study results of other thrombectomy trials.</p>
|
|
<p>Funded by industry and academia/government</p>
|
|
</td></tr><tr><th headers="hd_h_ch4.tab2_1_1_1_1 hd_h_ch4.tab2_1_1_1_2 hd_h_ch4.tab2_1_1_1_3 hd_h_ch4.tab2_1_1_1_4 hd_h_ch4.tab2_1_1_1_5" id="hd_b_ch4.tab2_1_1_10_1" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">Thrombectomy within 12 hours of stroke onset</th></tr><tr><td headers="hd_h_ch4.tab2_1_1_1_1 hd_b_ch4.tab2_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Goyal 2015<a class="bibr" href="#ch4.ref30" rid="ch4.ref30"><sup>30</sup></a><sup>,</sup>
|
|
<a class="bibr" href="#ch4.ref42" rid="ch4.ref42"><sup>42</sup></a></p>
|
|
<p>ESCAPE</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_2 hd_b_ch4.tab2_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Mechanical thrombectomy (within 12 hours) vs best medical practice</p>
|
|
<p>IV alteplase = 72.7% intervention, 78.7% control</p>
|
|
<p>Median (IQR) time from onset to IV thrombolysis: intervention 110 (80-142); control 125 (89-183) minutes</p>
|
|
<p>Median time from stroke onset to groin puncture in intervention group: 185 minutes</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_3 hd_b_ch4.tab2_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>n = 316</p>
|
|
<p>22 centres worldwide</p>
|
|
<p>Age ≥18</p>
|
|
<p>Mean age (range) intervention = 71 (60 - 81) control = 70 (60 - 81)</p>
|
|
<p>Patient selection criteria: evidence of occlusion on CTA</p>
|
|
<p>Median (IQR) NIHSS:</p>
|
|
<p>Intervention = 16 (13-20)</p>
|
|
<p>Control = 17 (12-20)
|
|
</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_4 hd_b_ch4.tab2_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Mortality at 90 days</p>
|
|
<p>mRS at 90 days</p>
|
|
<p>Symptomatic intracerebral haemorrhage</p>
|
|
<p>Stroke at 90 days</p>
|
|
<p>EQ-5D at 90 days</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_5 hd_b_ch4.tab2_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Trial stopped early due to release of MR CLEAN results (efficacy of thrombectomy).</p>
|
|
<p>Funded by industry and academia</p>
|
|
</td></tr><tr><th headers="hd_h_ch4.tab2_1_1_1_1 hd_h_ch4.tab2_1_1_1_2 hd_h_ch4.tab2_1_1_1_3 hd_h_ch4.tab2_1_1_1_4 hd_h_ch4.tab2_1_1_1_5" id="hd_b_ch4.tab2_1_1_12_1" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">Thrombectomy between 6 and 24 hours after stroke onset</th></tr><tr><td headers="hd_h_ch4.tab2_1_1_1_1 hd_b_ch4.tab2_1_1_12_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Albers 2018<a class="bibr" href="#ch4.ref7" rid="ch4.ref7"><sup>7</sup></a></p>
|
|
<p>DEFUSE 3</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_2 hd_b_ch4.tab2_1_1_12_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Mechanical thrombectomy (6 - 16 hours) plus standard medical therapy vs standard medical therapy</p>
|
|
<p>IV alteplase = 11% intervention, 9% control</p>
|
|
<p>Median time from onset to randomisation, intervention: 288 (216-372) and control: 336 (216468) minutes</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_3 hd_b_ch4.tab2_1_1_12_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>n = 182</p>
|
|
<p>38 centres in the USA</p>
|
|
<p>Age 18 - 90</p>
|
|
<p>Median age (IQR) intervention = 70 (59-79) control = 71 (59-80)</p>
|
|
<p>Patient selection criteria: evidence of occlusion on CTA or MRA and a MRI diffusion and perfusion or CT perfusion scans showing an initial infarct volume of <70 ml, a ratio of volume of ischaeminc tissue to initial infarct volume of 1.8 or more and a penumbra of 15 ml or more.</p>
|
|
<p>Median (IQR) NIHSS:</p>
|
|
<p>Intervention = 16 (10-20)</p>
|
|
<p>Control = 16 (12-21)</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_4 hd_b_ch4.tab2_1_1_12_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Mortality at 90 days</p>
|
|
<p>mRS at 90 days</p>
|
|
<p>Symptomatic intracerebral haemorrhage</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_5 hd_b_ch4.tab2_1_1_12_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Recruitment terminated early due to efficacy</td></tr><tr><td headers="hd_h_ch4.tab2_1_1_1_1 hd_b_ch4.tab2_1_1_12_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Nogueira 2018<a class="bibr" href="#ch4.ref76" rid="ch4.ref76"><sup>76</sup></a></p>
|
|
<p>DAWN</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_2 hd_b_ch4.tab2_1_1_12_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Mechanical thrombectomy (6 - 24 hours) plus standard care vs standard care</p>
|
|
<p>IV alteplase = 5% intervention, 13% control</p>
|
|
<p>Median time from onset to randomisation, intervention: 653 (526-741) and control: 644 (522-784) minutes</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_3 hd_b_ch4.tab2_1_1_12_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>n = 206</p>
|
|
<p>26 centres across USA, Canada, Europe and Australia</p>
|
|
<p>Age ≥18</p>
|
|
<p>Mean age (SD) intervention = 69.4 (14.1) control = 70.7 (13.2)</p>
|
|
<p>Patient selection criteria: evidence of occlusion on CTA or MRA and a mismatch between clinical severity and infarct volume assessed by DW MRI or perfusion CT.</p>
|
|
<p>Median (IQR) NIHSS:</p>
|
|
<p>Intervention = 17 (13-21)</p>
|
|
<p>Control = 17 (14-21)</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_4 hd_b_ch4.tab2_1_1_12_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Mortality at 90 days</p>
|
|
<p>mRS at 90 days</p>
|
|
<p>Symptomatic intracerebral haemorrhage</p>
|
|
<p>Procedural complications</p>
|
|
</td><td headers="hd_h_ch4.tab2_1_1_1_5 hd_b_ch4.tab2_1_1_12_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Funded by industry</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">ASPECTS: Alberta stroke program early CT Score; CTA; CT angiography; DSA: digital subtraction angiography; DW: diffusion-weighted; IQR: interquartile range; MRA: magnetic resonance angiography; NIHSS: National Institutes of Health Stroke Scale; SD: standard deviation; tPA: tissue plasminogen activator</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch4tab3"><div id="ch4.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Clinical evidence summary: thrombectomy within 6 hours with or without alteplase versus alteplase or standard medical care</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577865/table/ch4.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch4.tab3_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch4.tab3_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_ch4.tab3_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_ch4.tab3_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_ch4.tab3_1_1_1_2" style="text-align:left;vertical-align:bottom;">No of Participants (studies) Follow up</th><th id="hd_h_ch4.tab3_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_ch4.tab3_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_ch4.tab3_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_ch4.tab3_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_ch4.tab3_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_ch4.tab3_1_1_1_5" id="hd_h_ch4.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with Control</th><th headers="hd_h_ch4.tab3_1_1_1_5" id="hd_h_ch4.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with Thrombectomy plus medical management (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_ch4.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mortality at 90 days</td><td headers="hd_h_ch4.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1334</p>
|
|
<p>(6 studies)</p>
|
|
</td><td headers="hd_h_ch4.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>1</sup></p>
|
|
<p>due to imprecision</p>
|
|
</td><td headers="hd_h_ch4.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.9</p>
|
|
<p>(0.7 to 1.16)</p>
|
|
</td><td headers="hd_h_ch4.tab3_1_1_1_5 hd_h_ch4.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">157 per 1000</td><td headers="hd_h_ch4.tab3_1_1_1_5 hd_h_ch4.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>16 fewer per 1000</p>
|
|
<p>(from 47 fewer to 25 more)</p>
|
|
</td></tr><tr><td headers="hd_h_ch4.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Modified Rankin scale (0 - 2) 90 days</td><td headers="hd_h_ch4.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1324</p>
|
|
<p>(6 studies)</p>
|
|
</td><td headers="hd_h_ch4.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>2</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_ch4.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 1.47</p>
|
|
<p>(1.28 to 1.68)</p>
|
|
</td><td headers="hd_h_ch4.tab3_1_1_1_5 hd_h_ch4.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">377 per 1000</td><td headers="hd_h_ch4.tab3_1_1_1_5 hd_h_ch4.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>177 more per 1000</p>
|
|
<p>(from 106 more to 256 more)</p>
|
|
</td></tr><tr><td headers="hd_h_ch4.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Modified Rankin scale ordinal shift at 90 days</td><td headers="hd_h_ch4.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1324</p>
|
|
<p>(6 studies)</p>
|
|
</td><td headers="hd_h_ch4.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>MODERATE<sup>2</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_ch4.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 1.78</p>
|
|
<p>(1.47 to 2.16)<sup>3</sup></p>
|
|
</td><td headers="hd_h_ch4.tab3_1_1_1_5 hd_h_ch4.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Control rate not reported</td><td headers="hd_h_ch4.tab3_1_1_1_5 hd_h_ch4.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_ch4.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Symptomatic intracerebral haemorrhage at 90 days</td><td headers="hd_h_ch4.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1312</p>
|
|
<p>(6 studies)</p>
|
|
</td><td headers="hd_h_ch4.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊝⊝</p>
|
|
<p>LOW<sup>1</sup></p>
|
|
<p>due to imprecision</p>
|
|
</td><td headers="hd_h_ch4.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.98</p>
|
|
<p>(0.6 to 1.6)</p>
|
|
</td><td headers="hd_h_ch4.tab3_1_1_1_5 hd_h_ch4.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44 per 1000</td><td headers="hd_h_ch4.tab3_1_1_1_5 hd_h_ch4.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>1 fewer per 1000</p>
|
|
<p>(from 18 fewer to 26 more)</p>
|
|
</td></tr><tr><td headers="hd_h_ch4.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intracerebral haemorrhage</td><td headers="hd_h_ch4.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>65</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch4.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊝⊝</p>
|
|
<p>LOW<sup>1</sup></p>
|
|
<p>due to imprecision</p>
|
|
</td><td headers="hd_h_ch4.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.97</p>
|
|
<p>(0.21 to 4.45)</p>
|
|
</td><td headers="hd_h_ch4.tab3_1_1_1_5 hd_h_ch4.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">94 per 1000</td><td headers="hd_h_ch4.tab3_1_1_1_5 hd_h_ch4.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>3 fewer per 1000</p>
|
|
<p>(from 74 fewer to 324 more)</p>
|
|
</td></tr><tr><td headers="hd_h_ch4.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Any serious adverse event at 90 days</td><td headers="hd_h_ch4.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>800</p>
|
|
<p>(3 studies)</p>
|
|
</td><td headers="hd_h_ch4.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>1</sup></p>
|
|
<p>due to imprecision</p>
|
|
</td><td headers="hd_h_ch4.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 1.08</p>
|
|
<p>(0.92 to 1.28)</p>
|
|
</td><td headers="hd_h_ch4.tab3_1_1_1_5 hd_h_ch4.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">423 per 1000</td><td headers="hd_h_ch4.tab3_1_1_1_5 hd_h_ch4.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>34 more per 1000</p>
|
|
<p>(from 34 fewer to 118 more)</p>
|
|
</td></tr><tr><td headers="hd_h_ch4.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>EQ-5D at 90 days</p>
|
|
<p>Scores range from −0.33 to 1, with higher scores indicating a better quality of life</p>
|
|
</td><td headers="hd_h_ch4.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>260</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch4.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>2</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_ch4.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_ch4.tab3_1_1_1_5 hd_h_ch4.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The mean EQ-5D in the control group was 0.515</td><td headers="hd_h_ch4.tab3_1_1_1_5 hd_h_ch4.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean EQ-5D at 90 days in the intervention groups was 0.02 higher</p>
|
|
<p>(0.08 lower to 0.11 higher)</p>
|
|
</td></tr><tr><td headers="hd_h_ch4.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>EQ-5D at 90 days</p>
|
|
<p>Scores range from −0.33 to 1, with higher scores indicating a better quality of life</p>
|
|
</td><td headers="hd_h_ch4.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>500</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch4.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>2</sup><sup>,</sup><sup>5</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_ch4.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_ch4.tab3_1_1_1_5 hd_h_ch4.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The median EQ-5D in the control group was 0.66</td><td headers="hd_h_ch4.tab3_1_1_1_5 hd_h_ch4.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The median EQ-5D at 90 days in the intervention group was 0.03 higher</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="ch4.tab3_1"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed 1 MID or by 2 increments if the confidence interval crossed both MIDs</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="ch4.tab3_2"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="ch4.tab3_3"><p class="no_margin">Five studies provided an adjusted odds ratio but one study provided only an unadjusted estimate.</p></div></dd></dl><dl class="bkr_refwrap"><dt>4</dt><dd><div id="ch4.tab3_4"><p class="no_margin">Adjusted for age, NIHSS at baseline, time from stroke onset to randomisation, prior stroke, atrial fibrillation, diabetes mellitus and internal carotid artery terminus occlusion.</p></div></dd></dl><dl class="bkr_refwrap"><dt>5</dt><dd><div id="ch4.tab3_5"><p class="no_margin">Imprecision could not be assessed because non-parametric statistics were reported.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch4tab4"><div id="ch4.tab4" class="table"><h3><span class="label">Table 4</span><span class="title">Clinical evidence summary: thrombectomy within 8 hours with or without alteplase versus alteplase or standard medical care</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577865/table/ch4.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch4.tab4_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch4.tab4_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_ch4.tab4_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_ch4.tab4_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_ch4.tab4_1_1_1_2" style="text-align:left;vertical-align:bottom;">No of Participants (studies) Follow up</th><th id="hd_h_ch4.tab4_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_ch4.tab4_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_ch4.tab4_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_ch4.tab4_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_ch4.tab4_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_ch4.tab4_1_1_1_5" id="hd_h_ch4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with Control</th><th headers="hd_h_ch4.tab4_1_1_1_5" id="hd_h_ch4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with Thrombectomy plus medical management (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_ch4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mortality at 90 days</td><td headers="hd_h_ch4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>206</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊝⊝</p>
|
|
<p>LOW<sup>1</sup></p>
|
|
<p>due to imprecision</p>
|
|
</td><td headers="hd_h_ch4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 1.19</p>
|
|
<p>(0.65 to 2.18)</p>
|
|
</td><td headers="hd_h_ch4.tab4_1_1_1_5 hd_h_ch4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">155 per 1000</td><td headers="hd_h_ch4.tab4_1_1_1_5 hd_h_ch4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>29 more per 1000</p>
|
|
<p>(from 54 fewer to 183 more)</p>
|
|
</td></tr><tr><td headers="hd_h_ch4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mortality at 12 months</td><td headers="hd_h_ch4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>206</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊝⊝</p>
|
|
<p>LOW<sup>1</sup></p>
|
|
<p>due to imprecision</p>
|
|
</td><td headers="hd_h_ch4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.96</p>
|
|
<p>(0.59 to 1.57)</p>
|
|
</td><td headers="hd_h_ch4.tab4_1_1_1_5 hd_h_ch4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">243 per 1000</td><td headers="hd_h_ch4.tab4_1_1_1_5 hd_h_ch4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>10 fewer per 1000</p>
|
|
<p>(from 100 fewer to 139 more)</p>
|
|
</td></tr><tr><td headers="hd_h_ch4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Modified Rankin scale (0 - 2) 90 days</td><td headers="hd_h_ch4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>206</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊝⊝</p>
|
|
<p>LOW<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_ch4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 1.55</p>
|
|
<p>(1.06 to 2.27)</p>
|
|
</td><td headers="hd_h_ch4.tab4_1_1_1_5 hd_h_ch4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">282 per 1000</td><td headers="hd_h_ch4.tab4_1_1_1_5 hd_h_ch4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>155 more per 1000</p>
|
|
<p>(from 17 more to 358 more)</p>
|
|
</td></tr><tr><td headers="hd_h_ch4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Modified Rankin scale (0 - 2) at 1 year</td><td headers="hd_h_ch4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>206</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊝⊝</p>
|
|
<p>LOW<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_ch4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 1.45</p>
|
|
<p>(1.01 to 2.1)</p>
|
|
</td><td headers="hd_h_ch4.tab4_1_1_1_5 hd_h_ch4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">301 per 1000</td><td headers="hd_h_ch4.tab4_1_1_1_5 hd_h_ch4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>135 more per 1000</p>
|
|
<p>(from 3 more to 331 more)</p>
|
|
</td></tr><tr><td headers="hd_h_ch4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Modified Rankin scale ordinal shift at 90 days</td><td headers="hd_h_ch4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>206</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊝⊝</p>
|
|
<p>LOW<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_ch4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 1.7</p>
|
|
<p>(1.05 to 2.8)<sup>3</sup></p>
|
|
</td><td headers="hd_h_ch4.tab4_1_1_1_5 hd_h_ch4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Control rate not reported</td><td headers="hd_h_ch4.tab4_1_1_1_5 hd_h_ch4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_ch4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Modified Rankin scale ordinal shift at 1 year</td><td headers="hd_h_ch4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>206</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊝⊝</p>
|
|
<p>LOW<sup>2</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_ch4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 1.80</p>
|
|
<p>(1.09 to 2.99)<sup>3</sup></p>
|
|
</td><td headers="hd_h_ch4.tab4_1_1_1_5 hd_h_ch4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Control rate not reported</td><td headers="hd_h_ch4.tab4_1_1_1_5 hd_h_ch4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_ch4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Symptomatic intracerebral haemorrhage at 90</td><td headers="hd_h_ch4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>206</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊝⊝</p>
|
|
<p>LOW<sup>1</sup></p>
|
|
<p>due to imprecision</p>
|
|
</td><td headers="hd_h_ch4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 1.75</p>
|
|
<p>(0.53 to 5.8)</p>
|
|
</td><td headers="hd_h_ch4.tab4_1_1_1_5 hd_h_ch4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39 per 1000</td><td headers="hd_h_ch4.tab4_1_1_1_5 hd_h_ch4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>29 more per 1000</p>
|
|
<p>(from 18 fewer to 187 more)</p>
|
|
</td></tr><tr><td headers="hd_h_ch4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Recurrent stroke at 90 days</td><td headers="hd_h_ch4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>206</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊝⊝</p>
|
|
<p>LOW<sup>1</sup></p>
|
|
<p>due to imprecision</p>
|
|
</td><td headers="hd_h_ch4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 1.33</p>
|
|
<p>(0.31 to 5.81)</p>
|
|
</td><td headers="hd_h_ch4.tab4_1_1_1_5 hd_h_ch4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29 per 1000</td><td headers="hd_h_ch4.tab4_1_1_1_5 hd_h_ch4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>10 more per 1000</p>
|
|
<p>(from 20 fewer to 139 more)</p>
|
|
</td></tr><tr><td headers="hd_h_ch4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>EQ-5D at 90 days</p>
|
|
<p>Scores range from −0.33 to 1, with higher scores indicating a better quality of life</p>
|
|
</td><td headers="hd_h_ch4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>206</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>2</sup><sup>,</sup><sup>4</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_ch4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_ch4.tab4_1_1_1_5 hd_h_ch4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The median EQ-5D in the control group was 0.32</td><td headers="hd_h_ch4.tab4_1_1_1_5 hd_h_ch4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The median EQ-5D at 90 days in the intervention group was 0.33 higher</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="ch4.tab4_1"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed 1 MID or by 2 increments if the confidence interval crossed both MIDs</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="ch4.tab4_2"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="ch4.tab4_3"><p class="no_margin">Adjusted for minimisation factors (NIHSS, therapeutic window, occlusion site and participating centre) and alteplase use.</p></div></dd></dl><dl class="bkr_refwrap"><dt>4</dt><dd><div id="ch4.tab4_4"><p class="no_margin">Imprecision could not be assessed because non-parametric statistics were reported.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch4tab5"><div id="ch4.tab5" class="table"><h3><span class="label">Table 5</span><span class="title">Clinical evidence summary: thrombectomy within 12 hours with or without alteplase versus alteplase or standard medical care</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577865/table/ch4.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch4.tab5_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch4.tab5_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_ch4.tab5_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_ch4.tab5_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_ch4.tab5_1_1_1_2" style="text-align:left;vertical-align:bottom;">No of Participants (studies) Follow up</th><th id="hd_h_ch4.tab5_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_ch4.tab5_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_ch4.tab5_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_ch4.tab5_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_ch4.tab5_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_ch4.tab5_1_1_1_5" id="hd_h_ch4.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with Control</th><th headers="hd_h_ch4.tab5_1_1_1_5" id="hd_h_ch4.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with Thrombectomy plus medical management (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_ch4.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mortality at 90 days</td><td headers="hd_h_ch4.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>311</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch4.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>1</sup></p>
|
|
<p>due to imprecision</p>
|
|
</td><td headers="hd_h_ch4.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.54</p>
|
|
<p>(0.31 to 0.95)</p>
|
|
</td><td headers="hd_h_ch4.tab5_1_1_1_5 hd_h_ch4.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">191 per 1000</td><td headers="hd_h_ch4.tab5_1_1_1_5 hd_h_ch4.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>88 fewer per 1000</p>
|
|
<p>(from 10 fewer to 132 fewer)</p>
|
|
</td></tr><tr><td headers="hd_h_ch4.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Modified Rankin Scale (0 - 2) 90 days</td><td headers="hd_h_ch4.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>311</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch4.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>2</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_ch4.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 1.81</p>
|
|
<p>(1.36 to 2.42)</p>
|
|
</td><td headers="hd_h_ch4.tab5_1_1_1_5 hd_h_ch4.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">293 per 1000</td><td headers="hd_h_ch4.tab5_1_1_1_5 hd_h_ch4.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>237 more per 1000</p>
|
|
<p>(from 105 more to 416 more)</p>
|
|
</td></tr><tr><td headers="hd_h_ch4.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Modified Rankin Scale ordinal shift at 90 days</td><td headers="hd_h_ch4.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>316</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch4.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>2</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_ch4.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 3.1</p>
|
|
<p>(2.0 to 4.7)<sup>3</sup></p>
|
|
</td><td headers="hd_h_ch4.tab5_1_1_1_5 hd_h_ch4.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Control rate not reported</td><td headers="hd_h_ch4.tab5_1_1_1_5 hd_h_ch4.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_ch4.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Symptomatic intracerebral haemorrhage at 90 days</td><td headers="hd_h_ch4.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>315</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch4.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊝⊝</p>
|
|
<p>LOW<sup>1</sup></p>
|
|
<p>due to imprecision</p>
|
|
</td><td headers="hd_h_ch4.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 1.36</p>
|
|
<p>(0.39 to 4.74)</p>
|
|
</td><td headers="hd_h_ch4.tab5_1_1_1_5 hd_h_ch4.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27 per 1000</td><td headers="hd_h_ch4.tab5_1_1_1_5 hd_h_ch4.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>10 more per 1000</p>
|
|
<p>(from 16 fewer to 101 more)</p>
|
|
</td></tr><tr><td headers="hd_h_ch4.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Malignant middle cerebral syndrome at 90 days</td><td headers="hd_h_ch4.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>315</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch4.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊕</p>
|
|
<p>HIGH</p>
|
|
</td><td headers="hd_h_ch4.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.26</p>
|
|
<p>(0.12 to 0.55)</p>
|
|
</td><td headers="hd_h_ch4.tab5_1_1_1_5 hd_h_ch4.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">187 per 1000</td><td headers="hd_h_ch4.tab5_1_1_1_5 hd_h_ch4.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>138 fewer per 1000</p>
|
|
<p>(from 84 fewer to 165 fewer)</p>
|
|
</td></tr><tr><td headers="hd_h_ch4.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>EQ-5D at 90 days visual analogue scale</p>
|
|
<p>Score ranges from 0 - 100. 0 indicating worst possible quality of life and 100 the best possible quality of life.</p>
|
|
</td><td headers="hd_h_ch4.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>315</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch4.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>2</sup><sup>,</sup><sup>4</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_ch4.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_ch4.tab5_1_1_1_5 hd_h_ch4.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The median EQ-5D in the control group was 65</td><td headers="hd_h_ch4.tab5_1_1_1_5 hd_h_ch4.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The median (IQR) EQ-5D at 90 days in the intervention group was 15 higher</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="ch4.tab5_1"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed 1 MID or by 2 increments if the confidence interval crossed both MIDs</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="ch4.tab5_2"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="ch4.tab5_3"><p class="no_margin">Adjusted for age, sex, baseline NIHSS, baseline ASPECTS, occlusion location and alteplase use.</p></div></dd></dl><dl class="bkr_refwrap"><dt>4</dt><dd><div id="ch4.tab5_4"><p class="no_margin">Imprecision could not be assessed because non-parametric statistics were reported.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch4tab6"><div id="ch4.tab6" class="table"><h3><span class="label">Table 6</span><span class="title">Clinical evidence summary: thrombectomy between 6 - 24 hours onset of symptoms versus standard medical care</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577865/table/ch4.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch4.tab6_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch4.tab6_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_ch4.tab6_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_ch4.tab6_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_ch4.tab6_1_1_1_2" style="text-align:left;vertical-align:bottom;">No of Participants (studies) Follow up</th><th id="hd_h_ch4.tab6_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_ch4.tab6_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_ch4.tab6_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_ch4.tab6_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_ch4.tab6_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_ch4.tab6_1_1_1_5" id="hd_h_ch4.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with Control</th><th headers="hd_h_ch4.tab6_1_1_1_5" id="hd_h_ch4.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with Thrombectomy plus medical management (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_ch4.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mortality at 90 days</td><td headers="hd_h_ch4.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>388</p>
|
|
<p>(2 studies)</p>
|
|
</td><td headers="hd_h_ch4.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊝⊝</p>
|
|
<p>VERY LOW<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to inconsistency, imprecision</p>
|
|
</td><td headers="hd_h_ch4.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.76</p>
|
|
<p>(0.41 to 1.40)</p>
|
|
</td><td headers="hd_h_ch4.tab6_1_1_1_5 hd_h_ch4.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">219 per 1000</td><td headers="hd_h_ch4.tab6_1_1_1_5 hd_h_ch4.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>53 fewer per 1000</p>
|
|
<p>(from 129 fewer to 88 more)</p>
|
|
</td></tr><tr><td headers="hd_h_ch4.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Modified Rankin Scale (0 - 2) 90 days</td><td headers="hd_h_ch4.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>388</p>
|
|
<p>(2 studies)</p>
|
|
</td><td headers="hd_h_ch4.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>3</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_ch4.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 3.16</p>
|
|
<p>(2.17 to 4.59)</p>
|
|
</td><td headers="hd_h_ch4.tab6_1_1_1_5 hd_h_ch4.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">149 per 1000</td><td headers="hd_h_ch4.tab6_1_1_1_5 hd_h_ch4.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>322 more per 1000</p>
|
|
<p>(from 174 more to 535 more)</p>
|
|
</td></tr><tr><td headers="hd_h_ch4.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Modified Rankin Scale ordinal shift at 90 days</td><td headers="hd_h_ch4.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>182</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch4.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊝</p>
|
|
<p>MODERATE<sup>3</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_ch4.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 3.36</p>
|
|
<p>(1.96 to 5.77)<sup>4</sup></p>
|
|
</td><td headers="hd_h_ch4.tab6_1_1_1_5 hd_h_ch4.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Median 4 (IQR 3 - 6)</td><td headers="hd_h_ch4.tab6_1_1_1_5 hd_h_ch4.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_ch4.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Symptomatic intracerebral haemorrhage at 90 days</td><td headers="hd_h_ch4.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>388</p>
|
|
<p>(2 studies)</p>
|
|
</td><td headers="hd_h_ch4.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊝⊝</p>
|
|
<p>LOW<sup>2</sup></p>
|
|
<p>due to imprecision</p>
|
|
</td><td headers="hd_h_ch4.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 1.63</p>
|
|
<p>(0.66 to 4.06)</p>
|
|
</td><td headers="hd_h_ch4.tab6_1_1_1_5 hd_h_ch4.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37 per 1000</td><td headers="hd_h_ch4.tab6_1_1_1_5 hd_h_ch4.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>23 more per 1000</p>
|
|
<p>(from 13 fewer to 113 more)</p>
|
|
</td></tr><tr><td headers="hd_h_ch4.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Procedural complications</td><td headers="hd_h_ch4.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>206</p>
|
|
<p>(1 study)</p>
|
|
</td><td headers="hd_h_ch4.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⊕⊕⊕⊕</p>
|
|
<p>HIGH</p>
|
|
</td><td headers="hd_h_ch4.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>OR 7.27</p>
|
|
<p>(1.61 to 32.73)</p>
|
|
</td><td headers="hd_h_ch4.tab6_1_1_1_5 hd_h_ch4.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0 per 1000</td><td headers="hd_h_ch4.tab6_1_1_1_5 hd_h_ch4.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>70 more per 1000</p>
|
|
<p>(from 20 more to 120 more)<sup>5</sup></p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="ch4.tab6_1"><p class="no_margin">Downgraded by 1 increment for unexplained heterogeneity with I<sup>2</sup> >50%</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="ch4.tab6_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed 1 MID or by 2 increments if the confidence interval crossed both MIDs</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="ch4.tab6_3"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>4</dt><dd><div id="ch4.tab6_4"><p class="no_margin">Odds ratio adjusted for stratification factors (age, core infarct volume, time from symptom onset to enrolment, baseline NIHSS, and trial site).</p></div></dd></dl><dl class="bkr_refwrap"><dt>5</dt><dd><div id="ch4.tab6_5"><p class="no_margin">Calculated from risk difference</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch4tab7"><div id="ch4.tab7" class="table"><h3><span class="label">Table 7</span><span class="title">Health economic evidence profile: intravenous tissue-type plasminogen activator and endovascular therapy versus intravenous tissue-type plasminogen activator alone</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577865/table/ch4.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch4.tab7_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch4.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_ch4.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Applicability</th><th id="hd_h_ch4.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Limitations</th><th id="hd_h_ch4.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Other comments</th><th id="hd_h_ch4.tab7_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Incremental cost</th><th id="hd_h_ch4.tab7_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Incremental effects</th><th id="hd_h_ch4.tab7_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Cost effectiveness</th><th id="hd_h_ch4.tab7_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Uncertainty</th></tr></thead><tbody><tr><td headers="hd_h_ch4.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ganesalingam, 2015<a class="bibr" href="#ch4.ref38" rid="ch4.ref38"><sup>38</sup></a> (UK NHS and Personal Social Services perspective)</td><td headers="hd_h_ch4.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Directly applicable<sup>(a)</sup></td><td headers="hd_h_ch4.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Minor limitations<sup>(b)</sup></td><td headers="hd_h_ch4.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Decision analytic model with treatment effect from meta-analysis of five RCTs.<a class="bibr" href="#ch4.ref15" rid="ch4.ref15"><sup>15</sup></a>
|
|
<a class="bibr" href="#ch4.ref42" rid="ch4.ref42"><sup>42</sup></a>
|
|
<a class="bibr" href="#ch4.ref90" rid="ch4.ref90"><sup>90</sup></a>
|
|
<a class="bibr" href="#ch4.ref51" rid="ch4.ref51"><sup>51</sup></a>
|
|
<a class="bibr" href="#ch4.ref21" rid="ch4.ref21"><sup>21</sup></a> Markov model simulating a lifetime time horizon.</p>
|
|
</td><td headers="hd_h_ch4.tab7_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£7,296 (pa)<sup>(e)</sup></td><td headers="hd_h_ch4.tab7_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.954 QALYs (pa)</td><td headers="hd_h_ch4.tab7_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ICER: £7,648 per QALY gained (pa)</td><td headers="hd_h_ch4.tab7_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>95% CI: £5,481-£9,690 per QALY gained (pa)</p>
|
|
<p>Probability IV-tPA and mechanical thrombectomy cost effective (£20K/30K threshold): 100%/100%</p>
|
|
</td></tr><tr><td headers="hd_h_ch4.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lobotesis, 2016<a class="bibr" href="#ch4.ref61" rid="ch4.ref61"><sup>61</sup></a> (UK)</td><td headers="hd_h_ch4.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Directly applicable<sup>(a)</sup></td><td headers="hd_h_ch4.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Minor limitations<sup>(c)</sup></td><td headers="hd_h_ch4.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Decision analytic model with treatment effect from SWIFT-PRIME study only.<a class="bibr" href="#ch4.ref90" rid="ch4.ref90"><sup>90</sup></a>. Markov model with seven health states based on mRS simulating a lifetime time horizon.</td><td headers="hd_h_ch4.tab7_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Saves £33,190 (da)<sup>(e)</sup></td><td headers="hd_h_ch4.tab7_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.31 QALYs (da)</td><td headers="hd_h_ch4.tab7_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dominant<sup>(f)</sup> (da)</td><td headers="hd_h_ch4.tab7_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Probability IV-tPA and mechanical thrombectomy cost effective (£20K/30K threshold): 98.6%/99.0%</td></tr><tr><td headers="hd_h_ch4.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pizzo, 2019<a class="bibr" href="#ch4.ref84" rid="ch4.ref84"><sup>84</sup></a></td><td headers="hd_h_ch4.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Directly applicable<sup>(a)</sup></td><td headers="hd_h_ch4.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Minor limitations<sup>(d)</sup></td><td headers="hd_h_ch4.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Decision analytic model with treatment effects at 12 and 24 hours after stroke onset from DAWN RCT and at 16 hours after stroke onset from DEFUSE-3 RCT.<a class="bibr" href="#ch4.ref7" rid="ch4.ref7"><sup>7</sup></a><sup>,</sup>
|
|
<a class="bibr" href="#ch4.ref76" rid="ch4.ref76"><sup>76</sup></a> Markov model simulating a lifetime time horizon.</td><td headers="hd_h_ch4.tab7_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p><b>12 hours after stroke onset:</b> £1,995 (pa)<sup>(g)</sup></p>
|
|
<p><b>16 hours after stroke onset:</b> £6,919 (pa)<sup>(g)</sup></p>
|
|
<p><b>24 hours after stroke onset:</b> £6,466 (pa)<sup>(g)</sup></p>
|
|
</td><td headers="hd_h_ch4.tab7_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p><b>12 hours after stroke onset:</b> 1.63 QALYs (pa)</p>
|
|
<p><b>16 hours after stroke onset:</b> 1.69 QALYs (pa)</p>
|
|
<p><b>24 hours after stroke onset:</b> 2.23 QALYs (pa)</p>
|
|
</td><td headers="hd_h_ch4.tab7_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p><b>12 hours after stroke onset: ICER:</b> £1,227 per QALY gained (pa)</p>
|
|
<p><b>16 hours after stroke onset: ICER:</b> £4,103 per QALY gained (pa)</p>
|
|
<p><b>24 hours after stroke onset: ICER:</b> £2,894 per QALY gained (pa)</p>
|
|
</td><td headers="hd_h_ch4.tab7_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p><b>12 hours after stroke onset:</b> 95% CI: Dominant<sup>(f)</sup> - £2,879 per QALY gained (pa)</p>
|
|
<p><b>16 hours after stroke onset:</b> 95% CI: £2,417 - £6,214 per QALY gained (pa)</p>
|
|
<p><b>24 hours after stroke onset:</b> 95% CI: £1,588 - £4,311 per QALY gained (pa)</p>
|
|
<p>Probability medical therapy followed by mechanical thrombectomy cost effective (£20K/30K threshold): 99.9%/99.9%.</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Abbreviations: 95% CI: 95% confidence interval; da: deterministic analysis; ICER: incremental cost-effectiveness ratio; mRS: modified Rankin Scale; pa: probabilistic analysis; QALY: quality-adjusted life years; pa: probabilistic analysis; RCT: randomised controlled trial</p></div></dd></dl><dl class="bkr_refwrap"><dt>(a)</dt><dd><div id="ch4.tab7_1"><p class="no_margin">UK NHS and Personal Social Services perspective</p></div></dd></dl><dl class="bkr_refwrap"><dt>(b)</dt><dd><div id="ch4.tab7_2"><p class="no_margin">Components of ongoing costs were not detailed. Start age of those entering the model nor male:female ratio were reported, but as UK stroke national audit data was used to populate the model these could likely be found from these data. Treatment effect used in study did not include data from THRACE, THERAPY and PISTE RCTs, which were included in the 0-6 hour pre-specified subgroup analysis in the clinical review,<a class="bibr" href="#ch4.ref17" rid="ch4.ref17"><sup>17</sup></a><a class="bibr" href="#ch4.ref66" rid="ch4.ref66"><sup>66</sup></a><a class="bibr" href="#ch4.ref71" rid="ch4.ref71"><sup>71</sup></a> The treatment effect included REVASCAT and ESCAPE RCTs, which were not included in the 0-6 hour pre-specified subgroup analysis as they considered thrombectomy within 8 hours and within 12 hours of stroke onset, respectively.<a class="bibr" href="#ch4.ref42" rid="ch4.ref42"><sup>42</sup></a><a class="bibr" href="#ch4.ref51" rid="ch4.ref51"><sup>51</sup></a>.T. Sunderland in employment of Boehringer Ingleheim</p></div></dd></dl><dl class="bkr_refwrap"><dt>(c)</dt><dd><div id="ch4.tab7_3"><p class="no_margin">Health outcomes and treatment effects were based on the SWIFT-PRIME study only. The male:female ratio of those populating the model was not recorded, but could be elicited from the SWIFT-PRIME population. Funded by Medtronic, the manufacturer of Solitaire. Declarations of financial/other relationships with Medtronic, Boehringer Ingelheim and others.</p></div></dd></dl><dl class="bkr_refwrap"><dt>(d)</dt><dd><div id="ch4.tab7_4"><p class="no_margin">Components of ongoing costs not detailed.</p></div></dd></dl><dl class="bkr_refwrap"><dt>(e)</dt><dd><div id="ch4.tab7_5"><p class="no_margin">2013-2014 UK pounds</p></div></dd></dl><dl class="bkr_refwrap"><dt>(f)</dt><dd><div id="ch4.tab7_6"><p class="no_margin">A dominant treatment option is one that is both less costly and results in better health outcomes than the comparator treatment2017 UK pounds</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch4tab8"><div id="ch4.tab8" class="table"><h3><span class="label">Table 8</span><span class="title">UK costs of endovascular therapy, perfusion imaging and intravenous tissue-type plasminogen activator and endovascular therapy</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577865/table/ch4.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch4.tab8_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch4.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Currency Description</th><th id="hd_h_ch4.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unit Cost</th></tr></thead><tbody><tr><td headers="hd_h_ch4.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Endovascular therapy (YA12Z Percutaneous Transluminal, Other Procedures on, Intracerebral or Extracranial Blood Vessel, weighted average non-elective short stay and non-elective long stay inclusive of excess bed days; as recorded for Non-Elective Inpatients)</td><td headers="hd_h_ch4.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£8,115 (average length of stay: 7.1 days)</td></tr><tr><td headers="hd_h_ch4.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Computerised Tomography Perfusion (RD21A Computerised Tomography Scan of One Area, with PostContrast Only, 19 years and over, Direct Access)</td><td headers="hd_h_ch4.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£106</td></tr><tr><td headers="hd_h_ch4.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Computerised Tomography Angiography (Cardiac CT Angiography) (RD28Z Complex Computerised Tomography Scan, Direct Access)</td><td headers="hd_h_ch4.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£121</td></tr><tr><td headers="hd_h_ch4.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Post-Contrast Magnetic Resonance Imaging (RD02A Magnetic Resonance Imaging Scan of One Area, with Post-Contrast Only, 19 years and over, Direct Access)</td><td headers="hd_h_ch4.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£202</td></tr><tr><td headers="hd_h_ch4.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Magnetic Resonance Angiography (RD02A Magnetic Resonance Imaging Scan of One Area, with Post-Contrast Only, 19 years and over, Direct Access)</td><td headers="hd_h_ch4.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£202</td></tr><tr><td headers="hd_h_ch4.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Alteplase (rt-PA; Tissue-type plasminogen activator) 10mg (1 vial)<sup>(a)</sup></td><td headers="hd_h_ch4.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£172.80</td></tr><tr><td headers="hd_h_ch4.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Alteplase (rt-PA; Tissue-type plasminogen activator) 20mg (1 vial)<sup>(a)</sup></td><td headers="hd_h_ch4.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£259.20</td></tr><tr><td headers="hd_h_ch4.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Alteplase (rt-PA; Tissue-type plasminogen activator) 50mg (1 vial)<sup>(a)</sup></td><td headers="hd_h_ch4.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£432.00</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Sources: NHS Reference Costs, 2016-2017; British National Formulary</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch4tab9"><div id="ch4.tab9" class="table"><h3><span class="label">Table 9</span><span class="title">UK costs of intravenous tissue-type plasminogen activator</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577865/table/ch4.tab9/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch4.tab9_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch4.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Drug</th><th id="hd_h_ch4.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Daily dose<sup>(b)</sup></th><th id="hd_h_ch4.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost per 50mg vial (£)</th><th id="hd_h_ch4.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost per 20mg vial (£)</th><th id="hd_h_ch4.tab9_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Total Cost (70mg)</th></tr></thead><tbody><tr><td headers="hd_h_ch4.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Alteplase (rt-PA; Tissue-type plasminogen activator)</td><td headers="hd_h_ch4.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">68.4mg<sup>(c)</sup></td><td headers="hd_h_ch4.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£432.00</td><td headers="hd_h_ch4.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£259.20</td><td headers="hd_h_ch4.tab9_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£691.20</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Sources: MIMS; British National Formulary</p></div></dd></dl><dl class="bkr_refwrap"><dt>(a)</dt><dd><div id="ch4.tab9_1"><p class="no_margin">Indications: adult 18-79 years</p></div></dd></dl><dl class="bkr_refwrap"><dt>(b)</dt><dd><div id="ch4.tab9_2"><p class="no_margin">Dose: initially 900 micrograms/kg (maximum per dose 90mg) treatment must begin within 4.5 hours of symptom onset, to be given over 60 minutes, the initial 10% of dose is to be administered by intravenous injection and the remainder by intravenous infusion</p></div></dd></dl><dl class="bkr_refwrap"><dt>(c)</dt><dd><div id="ch4.tab9_3"><p class="no_margin">Dose assuming an average weight of 76kg<a class="bibr" href="#ch4.ref75" rid="ch4.ref75"><sup>75</sup></a></p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch4appatab1"><div id="ch4.appa.tab1" class="table"><h3><span class="label">Table 10</span><span class="title">Review protocol: thrombectomy</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577865/table/ch4.appa.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch4.appa.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Field</th><th id="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Content</th></tr></thead><tbody><tr><td headers="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Review question</td><td headers="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">What is the clinical and cost effectiveness of endovascular therapy (EVT) with or without intravenous thrombolysis versus intravenous thrombolysis to improve outcomes?</td></tr><tr><td headers="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Type of review question</td><td headers="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Intervention</p>
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<p>A review of health economic evidence related to the same review question was conducted in parallel with this review. For details see the health economic review protocol for this NICE guideline.</p>
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</td></tr><tr><td headers="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Objective of the review</td><td headers="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Thrombolysis and thrombectomy are separate interventions, however there is some overlap of populations: some people can have both treatments, and some can have alteplase only, some can have thrombectomy only.</p>
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<p>Guidance on identifying patients who would benefit from thrombectomy and transporting patients to a centre that can perform thrombectomy was thought to be needed.</p>
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</td></tr><tr><td headers="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria – population / disease / condition / issue / domain</td><td headers="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>People aged over 16 with acute ischaemic stroke</p>
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<p>People with a proven large vessel occlusion on non invasive angiography</p>
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</td></tr><tr><td headers="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria – interventions</td><td headers="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Endovascular therapies</p>
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<p>Mechanical thrombectomy including stent retrievers/technology and aspiration catheters (thrombo aspiration, mechanical suction, clot retrievers, ADAPT, solitaire, trevo)</p>
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<p>With or without intravenous thrombolysis (alteplase)</p>
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</td></tr><tr><td headers="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria – comparators</td><td headers="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Intravenous thrombolysis (alteplase)</p>
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<p>Aspirin, no IV thrombolysis,</p>
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<p>As above, compared to each other or no treatment (e.g. outside the time window, poor pre-morbid state, rapidly improving symptoms)</p>
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</td></tr><tr><td headers="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes and prioritisation</td><td headers="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<u>Critical</u>
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</p>
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<p>Degree of disability or dependence in daily activities: Modified Rankin Scale at 90 days and 1 year (0–2 for anterior circulation stroke stratum and 0–3 for posterior circulation stroke stratum because this condition carries a much higher mortality)</p>
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<p>Mortality at 90 days and 1 year</p>
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<p>
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<u>Important</u>
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</p>
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<p>Intracerebral haemorrhage.</p>
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<p>Symptomatic intracranial haemorrhage</p>
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<p>Patient reported outcome measures.</p>
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<p>Quality of life (both health- and social-related quality).</p>
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<p>Length of stay in hospital</p>
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<p>Procedural complications</p>
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</td></tr><tr><td headers="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eligibility criteria – study design</td><td headers="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Randomised controlled trials</p>
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<p>Systematic reviews and meta-analyses of the above</p>
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<p>Observational studies with multivariable analysis if no RCTs are identified</p>
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</td></tr><tr><td headers="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other inclusion exclusion criteria</td><td headers="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Inclusion</p>
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<p>Language: Restrict to English only</p>
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<p>Date restriction: 2015 for anterior circulation stroke population because newer devices for mechanical thrombectomy are known to be more effective than those used in trials published before 2015. Therefore, the results from trials before 2015 are not applicable to current practice. However, for posterior circulation stroke there has been no such “evolution” of technology either diagnostically or interventionally and it is not necessarily the case that the newer devices would be better because the physiology of the occlusions differ from those in the anterior circulation.</p>
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<p>Settings: Hospital, Emergency department,</p>
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<p>Stroke Unit, CT scanning suite, Angiography suite</p>
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</td></tr><tr><td headers="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Proposed sensitivity / subgroup analysis, or meta-regression</td><td headers="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<u>Strata</u>
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</p>
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<p>People with posterior circulation stroke / anterior circulation strokes</p>
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<p>
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<u>Subgroups</u>
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</p>
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<p>People aged over 80</p>
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<p>Perfusion based imaging for selection for endovascular therapy</p>
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<p>Time from symptom onset to treatment <6 hr, >6</p>
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<p>People with lower NIHSS scores than 4 (or higher than 22),</p>
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<p>People with “wake-up strokes” but no changes on plain CT imaging.</p>
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<p>GA versus no GA</p>
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</td></tr><tr><td headers="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Selection process – duplicate screening / selection / analysis</td><td headers="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Studies are sifted by title and abstract. Potentially significant publications obtained in full text are then assessed against the inclusion criteria specified in this protocol.</td></tr><tr><td headers="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data management (software)</td><td headers="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="l95"><li id="lt273" class="half_rhythm"><div>EndNote will be used for reference management, sifting, citations and bibliographies.</div></li><li id="lt274" class="half_rhythm"><div>EviBASE will be used for data extraction and quality assessment for clinical studies.</div></li><li id="lt275" class="half_rhythm"><div>Pairwise meta-analyses will be performed using Cochrane Review Manager (RevMan5).</div></li><li id="lt276" class="half_rhythm"><div>GRADEpro will be used to assess the quality of evidence for each outcome.</div></li></ul></td></tr><tr><td headers="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Information sources – databases and dates</td><td headers="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Databases: Medline, Embase, Cochrane Library</p>
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<p>Key papers
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<ul id="l96"><li id="lt277" class="half_rhythm"><div>NICE IPG 548 Mechanical clot retrieval for treating acute ischaemic stroke.</div></li><li id="lt278" class="half_rhythm"><div>Broderick JP, Palesch YY, Demchuk AM et al. (7-3-2013) Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl.J Med 368:893-903.</div></li><li id="lt279" class="half_rhythm"><div>O’Rourke K, Berge E, Walsh CD et al. (2010) Percutaneous vascular interventions for acute ischaemic stroke. [Review]. Cochrane Database of Systematic Reviews CD007574.</div></li><li id="lt280" class="half_rhythm"><div>Saver JL, Goyal M, Bonafe A et al. (11-6-2015) Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. New England Journal of Medicine 372:2285-2295.</div></li><li id="lt281" class="half_rhythm"><div>Campbell BC, Mitchell PJ, Kleinig TJ et al. (12-3-2015) Endovascular therapy for ischemic stroke with perfusion-imaging selection. New England Journal of Medicine 372:1009-1018.</div></li><li id="lt282" class="half_rhythm"><div>Broderick JP, Berkhemer OA, Palesch YY et al. (2015) Endovascular Therapy Is Effective and Safe for Patients With Severe Ischemic Stroke: Pooled Analysis of Interventional Management of Stroke III and Multicenter Randomized Clinical Trial of Endovascular Therapy for Acute Ischemic Stroke in the Netherlands Data. Stroke 46:3416-3422.</div></li><li id="lt283" class="half_rhythm"><div>Jovin TG, Chamorro A, Cobo E et al. (11-6-2015) Thrombectomy within 8 hours after symptom onset in ischemic stroke. New England Journal of Medicine 372:2296-2306.</div></li><li id="lt284" class="half_rhythm"><div>Goyal M, Demchuk AM, Menon BK et al. (12-3-2015) Randomized assessment of rapid endovascular treatment of ischemic stroke. New England Journal of Medicine 372:1019-1030.</div></li><li id="lt285" class="half_rhythm"><div>Berkhemer OA, Fransen PS, Beumer D et al. (2015) A randomized trial of intraarterial treatment for acute ischemic stroke. New England Journal of Medicine 372:11-20.</div></li></ul></p>
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</td></tr><tr><td headers="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Identify if an update</td><td headers="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>No. Thrombectomy was not reviewed in CG68, but alteplase was reviewed.</p>
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<p>
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<b>Recommendations from CG68 2008</b>
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</p>
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<p>What is the safety and efficacy of anticoagulants versus placebo for the treatment of patients with acute ischaemic stroke?</p>
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<p>No question was asked regarding endovascular therapy.</p>
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<p>1.4.1.1 Alteplase is recommended within its marketing authorisation for treating acute ischaemic stroke in adults if:
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<ul id="l97"><li id="lt286" class="half_rhythm"><div>treatment is started as early as possible within 4.5 hours of onset of stroke symptoms, and</div></li><li id="lt287" class="half_rhythm"><div>intracranial haemorrhage has been excluded by appropriate imaging techniques.</div></li></ul>
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1.4.1.2 Alteplase should be administered only within a well organised stroke service with:
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<ul id="l98"><li id="lt288" class="half_rhythm"><div>staff trained in delivering thrombolysis and in monitoring for any complications associated with thrombolysis</div></li><li id="lt289" class="half_rhythm"><div>level 1 and level 2 nursing care staff trained in acute stroke and thrombolysis</div></li><li id="lt290" class="half_rhythm"><div>immediate access to imaging and re-imaging, and staff trained to interpret the images.</div></li></ul>
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1.4.1.3 Staff in A&E departments, if appropriately trained and supported, can administer alteplase for the treatment of acute ischaemic stroke provided that patients can be managed within an acute stroke service with appropriate neuroradiological and stroke physician support.</p>
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<p>1.4.1.4 Protocols should be in place for the delivery and management of thrombolysis, including post-thrombolysis complications.</p>
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</td></tr><tr><td headers="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Author contacts</td><td headers="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a href="https://www.nice.org.uk/guidance/indevelopment/gid-ng10071" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.nice.org<wbr style="display:inline-block"></wbr>​.uk/guidance/indevelopment/gid-ng10071</a>
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</td></tr><tr><td headers="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Highlight if amendment to previous protocol</td><td headers="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see section 4.5 of <a href="https://www.nice.org.uk/article/pmg20/chapter/4-Developing-review-questions-and-planning-the-evidence-review#planning-the-evidence-review" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</td></tr><tr><td headers="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Search strategy – for one database</td><td headers="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see <a href="#ch4.appb">appendix B</a></td></tr><tr><td headers="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data collection process – forms / duplicate</td><td headers="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>A standardised evidence table format will be used, and published as <a href="#ch4.appd">appendix D</a> of the evidence report.</p>
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<p>For non-randomised studies, we will note which confounding variables have been accounted for in the analysis and by what method. The following confounding variables were agreed to be important:
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<ul id="l99"><li id="lt291" class="half_rhythm"><div>age (any age cut offs)</div></li><li id="lt292" class="half_rhythm"><div>pre-intervention measures of stroke severity/Glasgow coma scale</div></li><li id="lt293" class="half_rhythm"><div>pre-morbid mRS</div></li><li id="lt294" class="half_rhythm"><div>imaging confounders (e.g., excluding those with evidence of brain stem infarction/compromise)</div></li><li id="lt295" class="half_rhythm"><div>IV thrombolysis before intervention (yes/no)</div></li><li id="lt296" class="half_rhythm"><div>time from symptom onset to intervention</div></li></ul></p>
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</td></tr><tr><td headers="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Data items – define all variables to be collected</td><td headers="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see evidence tables in <a href="#ch4.appd">Appendix D</a> (clinical evidence tables) or <a href="#ch4.apph">H</a> (health economic evidence tables).</td></tr><tr><td headers="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Methods for assessing bias at outcome / study level</td><td headers="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Standard study checklists were used to critically appraise individual studies. For details please see section 6.2 of <a href="https://www.nice.org.uk/article/pmg20/chapter/6-Reviewing-research-evidence#assessing-the-quality-of-the-evidence" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a></p>
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<p>The risk of bias across all available evidence was evaluated for each outcome using an adaptation of the ‘Grading of Recommendations Assessment, Development and Evaluation (GRADE) toolbox’ developed by the international GRADE working group <a href="http://www.gradeworkinggroup.org/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.gradeworkinggroup.org/</a></p>
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<p>[Please document any deviations/alternative approach when GRADE isn’t used or if a modified GRADE approach has been used for non-intervention or non-comparative studies.]</p>
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</td></tr><tr><td headers="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Criteria for quantitative synthesis</td><td headers="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see section 6.4 of <a href="https://www.nice.org.uk/article/pmg20/chapter/6-Reviewing-research-evidence#assessing-the-quality-of-the-evidence" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</td></tr><tr><td headers="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Methods for quantitative analysis – combining studies and exploring (in)consistency</td><td headers="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see the separate Methods report for this guideline.</td></tr><tr><td headers="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meta-bias assessment – publication bias, selective reporting bias</td><td headers="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see section 6.2 of <a href="https://www.nice.org.uk/article/pmg20/chapter/6-Reviewing-research-evidence#assessing-the-quality-of-the-evidence" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</td></tr><tr><td headers="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Confidence in cumulative evidence</td><td headers="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see sections 6.4 and 9.1 of <a href="https://www.nice.org.uk/article/pmg20/chapter/1-Introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</td></tr><tr><td headers="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rationale / context – what is known</td><td headers="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For details please see the introduction to the evidence review.</td></tr><tr><td headers="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Describe contributions of authors and guarantor</td><td headers="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>A <a href="https://www.nice.org.uk/guidance/indevelopment/gid-ng10071/documents" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">multidisciplinary committee</a> developed the evidence review. The committee was convened by the National Guideline Centre (NGC) and chaired by Jason Kendall in line with section 3 of <a href="https://www.nice.org.uk/article/pmg20/chapter/1%20Introduction%20and%20overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</p>
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<p>Staff from NGC undertook systematic literature searches, appraised the evidence, conducted meta-analysis and cost-effectiveness analysis where appropriate, and drafted the evidence review in collaboration with the committee. For details please see <a href="https://www.nice.org.uk/article/pmg20/chapter/1-Introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>.</p>
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</td></tr><tr><td headers="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sources of funding / support</td><td headers="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NGC is funded by NICE and hosted by the Royal College of Physicians.</td></tr><tr><td headers="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Name of sponsor</td><td headers="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NGC is funded by NICE and hosted by the Royal College of Physicians.</td></tr><tr><td headers="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Roles of sponsor</td><td headers="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NICE funds NGC to develop guidelines for those working in the NHS, public health and social care in England.</td></tr><tr><td headers="hd_h_ch4.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PROSPERO registration number</td><td headers="hd_h_ch4.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not registered</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch4appatab2"><div id="ch4.appa.tab2" class="table"><h3><span class="label">Table 11</span><span class="title">Health economic review protocol</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577865/table/ch4.appa.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch4.appa.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_ch4.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Review question</th><th id="hd_h_ch4.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">All questions – health economic evidence</th></tr></thead><tbody><tr><td headers="hd_h_ch4.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<b>Objectives</b>
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</td><td headers="hd_h_ch4.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">To identify health economic studies relevant to any of the review questions.</td></tr><tr><td headers="hd_h_ch4.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<b>Search criteria</b>
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</td><td headers="hd_h_ch4.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul id="l100"><li id="lt297" class="half_rhythm"><div>Populations, interventions and comparators must be as specified in the clinical review protocol above.</div></li><li id="lt298" class="half_rhythm"><div>Studies must be of a relevant health economic study design (cost–utility analysis, cost-effectiveness analysis, cost–benefit analysis, cost–consequences analysis, comparative cost analysis).</div></li><li id="lt299" class="half_rhythm"><div>Studies must not be a letter, editorial or commentary, or a review of health economic evaluations. (Recent reviews will be ordered although not reviewed. The bibliographies will be checked for relevant studies, which will then be ordered.)</div></li><li id="lt300" class="half_rhythm"><div>Unpublished reports will not be considered unless submitted as part of a call for evidence.</div></li><li id="lt301" class="half_rhythm"><div>Studies must be in English.</div></li></ul></td></tr><tr><td headers="hd_h_ch4.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<b>Search strategy</b>
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</td><td headers="hd_h_ch4.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A health economic study search will be undertaken using population-specific terms and a health economic study filter – see <a href="#ch4.appb.s2">appendix B2</a> of reviews. For questions being updated, the search will be run from 2007, which was the cut-off date for the searches conducted for NICE guideline CG68. For the new review question on endovascular therapy, the search will be run from 2007 as studies published before 2007 are not likely to be relevant.</td></tr><tr><td headers="hd_h_ch4.appa.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<b>Review strategy</b>
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</td><td headers="hd_h_ch4.appa.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Studies not meeting any of the search criteria above will be excluded. Studies published before 2002, abstract-only studies and studies from non-OECD countries or the USA will also be excluded.</p>
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<p>Studies published after 2002 that were included in the previous guideline will be reassessed for inclusion and may be included or selectively excluded based on their relevance to the questions covered in this update and whether more applicable evidence is also identified.</p>
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<p>Each remaining study will be assessed for applicability and methodological limitations using the NICE economic evaluation checklist which can be found in <a href="#ch4.apph">appendix H</a> of Developing NICE guidelines: the manual (2014).<a class="bibr" href="#ch4.ref74" rid="ch4.ref74"><sup>74</sup></a></p>
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<p><b>Inclusion and exclusion criteria</b>
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<ul id="l101"><li id="lt302" class="half_rhythm"><div>If a study is rated as both ‘Directly applicable’ and with ‘Minor limitations’ then it will be included in the guideline. A health economic evidence table will be completed and it will be included in the health economic evidence profile.</div></li><li id="lt303" class="half_rhythm"><div>If a study is rated as either ‘Not applicable’ or with ‘Very serious limitations’ then it will usually be excluded from the guideline. If it is excluded then a health economic evidence table will not be completed and it will not be included in the health economic evidence profile.</div></li><li id="lt304" class="half_rhythm"><div>If a study is rated as ‘Partially applicable’, with ‘Potentially serious limitations’ or both then there is discretion over whether it should be included.</div></li></ul>
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<b>Where there is discretion</b></p>
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<p>The health economist will make a decision based on the relative applicability and quality of the available evidence for that question, in discussion with the guideline committee if required. The ultimate aim is to include health economic studies that are helpful for decision-making in the context of the guideline and the current NHS setting. If several studies are considered of sufficiently high applicability and methodological quality that they could all be included, then the health economist, in discussion with the committee if required, may decide to include only the most applicable studies and to selectively exclude the remaining studies. All studies excluded on the basis of applicability or methodological limitations will be listed with explanation as excluded health economic studies in <a href="#ch4.apph">appendix H</a>.</p>
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<p>The health economist will be guided by the following hierarchies.</p>
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<p><i>Setting:</i>
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<ul id="l102"><li id="lt305" class="half_rhythm"><div>UK NHS (most applicable).</div></li><li id="lt306" class="half_rhythm"><div>OECD countries with predominantly public health insurance systems (for example, France, Germany, Sweden).</div></li><li id="lt307" class="half_rhythm"><div>OECD countries with predominantly private health insurance systems (for example, Switzerland).</div></li><li id="lt308" class="half_rhythm"><div>Studies set in non-OECD countries or in the USA will be excluded before being assessed for applicability and methodological limitations.</div></li></ul>
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<i>Health economic study type:</i>
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<ul id="l103"><li id="lt309" class="half_rhythm"><div>Cost–utility analysis (most applicable).</div></li><li id="lt310" class="half_rhythm"><div>Other type of full economic evaluation (cost–benefit analysis, cost-effectiveness analysis, cost–consequences analysis).</div></li><li id="lt311" class="half_rhythm"><div>Comparative cost analysis.</div></li><li id="lt312" class="half_rhythm"><div>Non-comparative cost analyses including cost-of-illness studies will be excluded before being assessed for applicability and methodological limitations.</div></li></ul>
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<i>Year of analysis:</i>
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<ul id="l104"><li id="lt313" class="half_rhythm"><div>The more recent the study, the more applicable it will be.</div></li><li id="lt314" class="half_rhythm"><div>Studies published in 2002 or later (including any such studies included in the previous guideline) but that depend on unit costs and resource data entirely or predominantly from before 2002 will be rated as ‘Not applicable’.</div></li><li id="lt315" class="half_rhythm"><div>Studies published before 2002 (including any such studies included in the previous guideline) will be excluded before being assessed for applicability and methodological limitations.</div></li></ul>
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<i>Quality and relevance of effectiveness data used in the health economic analysis:</i>
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<ul id="l105"><li id="lt316" class="half_rhythm"><div>The more closely the clinical effectiveness data used in the health economic analysis match with the outcomes of the studies included in the clinical review the more useful the analysis will be for decision-making in the guideline.</div></li></ul></p>
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</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch4appbtab1"><div id="ch4.appb.tab1" class="table"><h3><span class="label">Table 12</span><span class="title">Database date parameters and filters used</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577865/table/ch4.appb.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch4.appb.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_ch4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Database</th><th id="hd_h_ch4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dates searched</th><th id="hd_h_ch4.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Search filter used</th></tr></thead><tbody><tr><td headers="hd_h_ch4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medline (OVID)</td><td headers="hd_h_ch4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1946 – 02 August 2018</td><td headers="hd_h_ch4.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Exclusions</p>
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<p>Randomised controlled trials</p>
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<p>Systematic review studies</p>
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</td></tr><tr><td headers="hd_h_ch4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Embase (OVID)</td><td headers="hd_h_ch4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1974 – 02 August 2018</td><td headers="hd_h_ch4.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Exclusions</p>
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<p>Randomised controlled trials</p>
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<p>Systematic review studies</p>
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</td></tr><tr><td headers="hd_h_ch4.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The Cochrane Library (Wiley)</td><td headers="hd_h_ch4.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Cochrane Reviews to 2018 Issue 8 of 12</p>
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<p>CENTRAL to 2018 Issue 7 of 12</p>
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<p>DARE, and NHSEED to 2015 Issue 2 of 4</p>
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<p>HTA to 2016 Issue 4 of 4</p>
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</td><td headers="hd_h_ch4.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch4appbtab2"><div id="ch4.appb.tab2" class="table"><h3><span class="title">Medline (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577865/table/ch4.appb.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch4.appb.tab2_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Stroke/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(stroke or strokes).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((cerebro* or cerebral*) adj2 (accident* or apoplexy)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(CVA or poststroke or poststrokes).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Intracranial Hemorrhages/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(brain adj2 (attack*1 or hemorrhag* or haemorrhag* or bleed* or infarct*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((intracerebral or intracranial or cerebral* or cerebro* or cerebrum or cerebellum or subarachnoid* or choroidal or basal ganglia or subdural) adj3 (hemorrhag* or haemorrhag* or bleed*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Brain infarction/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “Intracranial Embolism and Thrombosis”/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Carotid Artery Thrombosis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((brain or brainstem or cerebr* or cerebell* or vertebrobasil* or verte brobasil* or vertebro basil* or hemisphere* or intracran* or intracerebral or infratentorial or supratentorial or mca*1 or anterior circulation or carotid or transient or lacunar) adj3 (infarct* or thrombo* or emboli* or occlus* or hypoxi*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Brain Ischemia/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((brain or brainstem or cerebr* or cerebell* or vertebrobasil* or verte brobasil* or vertebro basil* or hemisphere* or intracran* or intracerebral or infratentorial or supratentorial or mca*1 or anterior circulation or carotid or crescendo or transient or lacunar) adj3 isch?emi*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ischemic Attack, Transient/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(isch?emi* adj2 attack*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">TIA*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-16</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">news/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp historical article/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anecdotes as Topic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">comment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/18-25</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26 not 27</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animals/ not humans/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animals, Laboratory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experimentation/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Models, Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodentia/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/28-34</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17 not 35</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 36 to English language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(exp child/ or exp pediatrics/ or exp infant/) not (exp adolescent/ or exp adult/ or exp middle age/ or exp aged/)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37 not 38</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tissue Plasminogen Activator/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(tPA or TPA or t-PA or rtPA or rt-PA or alteplase or activase or actilyse).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">‘recombinant human tissue-type plasminogen activator’.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp thrombectomy/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(thrombecto* or neurothrombecto*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(aspirat* or thromboaspirat*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((removal or disrupt* or excis* or retriev* or incorporat* or manipulat* or technolog*) adj3 (coil* or catheter* or stent*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(suction adj2 catheter*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(first pass adj3 technique*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(suction adj2 mechanic*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ADAPT.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(solitaire or trevo).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*Endovascular Procedures/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(endovascular adj2 (therap* or treatment* or procedure* or surger*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/40-53</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39 and 54</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">56.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">57.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">controlled clinical trial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">58.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomi#ed.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">59.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">placebo.ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">60.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomly.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">61.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">clinical trials as topic.sh.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">62.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">trial.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">63.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/56-62</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">64.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meta-Analysis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">65.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meta-Analysis as Topic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">66.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(meta analy* or metanaly* or metaanaly* or meta regression).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">67.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((systematic* or evidence*) adj3 (review* or overview*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">68.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(reference list* or bibliograph* or hand search* or manual search* or relevant journals).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">69.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search strategy or search criteria or systematic search or study selection or data extraction).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">70.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search* adj4 literature).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">71.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(medline or pubmed or cochrane or embase or psychlit or psyclit or psychinfo or psycinfo or cinahl or science citation index or bids or cancerlit).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">72.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cochrane.jw.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">73.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((multiple treatment* or indirect or mixed) adj2 comparison*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">74.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/64-73</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">75.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55 and (63 or 74)</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch4appbtab3"><div id="ch4.appb.tab3" class="table"><h3><span class="title">Embase (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577865/table/ch4.appb.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch4.appb.tab3_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*cerebrovascular accident/ or cardioembolic stroke/ or exp experimental stroke/ or lacunar stroke/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(stroke or strokes).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((cerebro* or cerebral*) adj2 (accident* or apoplexy)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(CVA or poststroke or poststrokes).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*brain hemorrhage/ or *brain ventricle hemorrhage/ or *cerebellum hemorrhage/ or *subarachnoid hemorrhage/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(brain adj2 (attack*1 or hemorrhag* or haemorrhag* or bleed* or infarct*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((intracerebral or intracranial or cerebral* or cerebro* or cerebrum or cerebellum or subarachnoid* or choroidal or basal ganglia or subdural) adj3 (hemorrhag* or haemorrhag* or bleed*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*brain infarction/ or *brain infarction size/ or *brain stem infarction/ or *cerebellum infarction/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*brain embolism/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*Carotid Artery Thrombosis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((brain or brainstem or cerebr* or cerebell* or vertebrobasil* or verte brobasil* or vertebro basil* or hemisphere* or intracran* or intracerebral or infratentorial or supratentorial or mca*1 or anterior circulation or carotid or transient or lacunar) adj3 (infarct* or thrombo* or emboli* or occlus* or hypoxi*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*brain ischemia/ or *hypoxic ischemic encephalopathy/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((brain or brainstem or cerebr* or cerebell* or vertebrobasil* or verte brobasil* or vetebro basil* or hemisphere* or intracran* or intracerebral or infratentorial or supratentorial or mca*1 or anterior circulation or carotid or crescendo or transient or lacunar) adj3 isch?emi*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*Transient ischemic attack/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(isch?emi* adj2 attack*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">TIA*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-16</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter.pt. or letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">note.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/ or case study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/18-22</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23 not 24</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal/ not human/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">nonhuman/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experiment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Experimental Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodent/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/25-32</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17 not 33</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 34 to English language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(exp child/ or exp pediatrics/) not (exp adult/ or exp adolescent/)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35 not 36</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*plasminogen activator/ or alteplase/ or plasminogen activator derivative/ or recombinant plasminogen activator/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(tPA or TPA or t-PA or rtPA or rt-PA or alteplase or activase or actilyse).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">‘recombinant human tissue-type plasminogen activator’.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp thrombectomy/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*mechanical thrombectomy/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">fibrinolytic therapy/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(thrombecto* or neurothrombecto*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(aspirat* or thromboaspirat*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((removal or disrupt* or excis* or retriev* or incorporat* or manipulat* or technolog*) adj3 (coil* or catheter* or stent*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(suction adj2 catheter*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(first pass adj3 technique*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(suction adj2 mechanic*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ADAPT.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(solitaire or trevo).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*Endovascular surgery/ or *endovascular aneurysm repair/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(endovascular adj2 (therap* or treatment* or procedure* or surger*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/38-53</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37 and 54</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">56.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">57.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">factorial*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">58.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(crossover* or cross over*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">59.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((doubl* or singl*) adj blind*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">60.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(assign* or allocat* or volunteer* or placebo*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">61.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">crossover procedure/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">62.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">single blind procedure/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">63.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">64.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">double blind procedure/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">65.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/56-64</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">66.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">systematic review/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">67.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meta-Analysis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">68.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(meta analy* or metanaly* or metaanaly* or meta regression).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">69.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((systematic* or evidence*) adj2 (review* or overview*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">70.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(reference list* or bibliograph* or hand search* or manual search* or relevant journals).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">71.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search strategy or search criteria or systematic search or study selection or data extraction).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">72.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search* adj4 literature).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">73.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(medline or pubmed or cochrane or embase or psychlit or psyclit or psychinfo or psycinfo or cinahl or science citation index or bids or cancerlit).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">74.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cochrane.jw.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">75.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((multiple treatment* or indirect or mixed) adj2 comparison*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">76.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/66-75</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">77.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55 and (65 or 76)</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch4appbtab4"><div id="ch4.appb.tab4" class="table"><h3><span class="title">Cochrane Library (Wiley) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577865/table/ch4.appb.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch4.appb.tab4_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Stroke] explode all trees</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(stroke or strokes):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((cerebro* or cerebral*) near/2 (accident* or apoplexy)):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(CVA or poststroke or poststrokes):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Intracranial Hemorrhages] explode all trees</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(brain near/2 (attack*1 or hemorrhag* or haemorrhag* or bleed* or infarct*)):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((intracerebral or intracranial or cerebral* or cerebro* or cerebrum or cerebellum or subarachnoid* or choroidal or basal ganglia or subdural) near/3 (hemorrhag* or haemorrhag* or bleed*)):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Brain Infarction] explode all trees</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Intracranial Embolism and Thrombosis] explode all trees</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Carotid Artery Thrombosis] explode all trees</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((brain or brainstem or cerebr* or cerebell* or vertebrobasil* or verte brobasil* or vertebro basil* or hemisphere* or intracran* or intracerebral or infratentorial or supratentorial or mca*1 or anterior circulation or carotid or transient or lacunar) near/3 (infarct* or thrombo* or emboli* or occlus* or hypoxi*)):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Brain Ischemia] explode all trees</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((brain or brainstem or cerebr* or cerebell* or vertebrobasil* or verte brobasil* or vertebro basil* or hemisphere* or intracran* or intracerebral or infratentorial or supratentorial or mca*1 or anterior circulation or carotid or crescendo or transient or lacunar) near/3 isch?emi*):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Ischemic Attack, Transient] explode all trees</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(isch?emi* near/2 attack*):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">TIA*:ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(or #1-#16)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Tissue Plasminogen Activator] explode all trees</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(tPA or TPA or t-PA or rtPA or rt-PA or alteplase or activase or actilyse):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">‘recombinant human tissue-type plasminogen activator’:ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Thrombectomy] explode all trees</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(thrombecto* or neurothrombecto*):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(aspirat* or thromboaspirat*):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((removal or disrupt* or excis* or retriev* or incorporat* or manipulat* or technolog*) near/3 (coil* or catheter* or stent*)):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(suction near/2 catheter*):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(first pass near/3 technique*) ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(suction near/2 mechanic*):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ADAPT:ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(solitaire or trevo):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Endovascular Procedures] explode all trees</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(endovascular near/2 (therap* or treatment* or procedure* or surger*)):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(or #18-#31)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#17 and #32</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch4appbtab5"><div id="ch4.appb.tab5" class="table"><h3><span class="label">Table 13</span><span class="title">Database date parameters and filters used</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577865/table/ch4.appb.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch4.appb.tab5_lrgtbl__"><table><thead><tr><th id="hd_h_ch4.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Database</th><th id="hd_h_ch4.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dates searched</th><th id="hd_h_ch4.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Search filter used</th></tr></thead><tbody><tr><td headers="hd_h_ch4.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medline</td><td headers="hd_h_ch4.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">01 January 2007 – 06 August 2018</td><td headers="hd_h_ch4.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Exclusions</p>
|
|
<p>Health economics studies</p>
|
|
</td></tr><tr><td headers="hd_h_ch4.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Embase</td><td headers="hd_h_ch4.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">01 January 2007 – 06 August 2018</td><td headers="hd_h_ch4.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Exclusions</p>
|
|
<p>Health economics studies</p>
|
|
</td></tr><tr><td headers="hd_h_ch4.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Centre for Research and Dissemination (CRD)</td><td headers="hd_h_ch4.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HTA - 01 January 2007 – 10 November 2017</p>
|
|
<p>NHSEED - 01 January 2007 – March 2015</p>
|
|
</td><td headers="hd_h_ch4.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch4appbtab6"><div id="ch4.appb.tab6" class="table"><h3><span class="title">Medline (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577865/table/ch4.appb.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch4.appb.tab6_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Stroke/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(stroke or strokes).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((cerebro* or cerebral*) adj2 (accident* or apoplexy)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(CVA or poststroke or poststrokes).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Intracranial Hemorrhages/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(brain adj2 (attack*1 or hemorrhag* or haemorrhag* or bleed* or infarct*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((intracerebral or intracranial or cerebral* or cerebro* or cerebrum or cerebellum or subarachnoid* or choroidal or basal ganglia or subdural) adj3 (hemorrhag* or haemorrhag* or bleed*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Brain infarction/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Carotid Artery Thrombosis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((brain or brainstem or cerebr* or cerebell* or vertebrobasil* or verte brobasil* or hemisphere* or intracran* or intracerebral or infratentorial or supratentorial or mca*1 or anterior circulation or carotid or transient or lacunar) adj3 (infarct* or thrombo* or emboli* or occlus* or hypoxi*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Brain Ischemia/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((brain or brainstem or cerebr* or cerebell* or vertebrobasil* or verte brobasil* or hemisphere* or intracran* or intracerebral or infratentorial or supratentorial or mca*1 or anterior circulation or carotid or crescendo or transient or lacunar) adj3 isch?emi*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ischemic Attack, Transient/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(isch?emi* adj2 attack*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">TIA.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-15</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">news/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp historical article/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anecdotes as Topic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">comment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/17-24</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25 not 26</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animals/ not humans/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animals, Laboratory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experimentation/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Models, Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodentia/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/27-33</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16 not 34</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 35 to English language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(exp child/ or exp pediatrics/ or exp infant/) not (exp adolescent/ or exp adult/ or exp middle age/ or exp aged/)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36 not 37</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">economics/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">value of life/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “costs and cost analysis”/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Economics, Hospital/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Economics, medical/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics, nursing/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">economics, pharmaceutical/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “Fees and Charges”/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp budgets/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cost*.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(economic* or pharmaco?economic*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(price* or pricing*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cost* adj2 (effectiv* or utilit* or benefit* or minimi* or unit* or estimat* or variable*)).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(financ* or fee or fees).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(value adj2 (money or monetary)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/39-54</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">56.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">and 55</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch4appbtab7"><div id="ch4.appb.tab7" class="table"><h3><span class="title">Embase (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577865/table/ch4.appb.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch4.appb.tab7_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*cerebrovascular accident/ or cardioembolic stroke/ or exp experimental stroke/ or lacunar stroke/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(stroke or strokes).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((cerebro* or cerebral*) adj2 (accident* or apoplexy)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(CVA or poststroke or poststrokes).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*brain hemorrhage/ or *brain ventricle hemorrhage/ or *cerebellum hemorrhage/ or *subarachnoid hemorrhage/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(brain adj2 (attack*1 or hemorrhag* or haemorrhag* or bleed* or infarct*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((intracerebral or intracranial or cerebral* or cerebro* or cerebrum or cerebellum or subarachnoid* or choroidal or basal ganglia or subdural) adj3 (hemorrhag* or haemorrhag* or bleed*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*brain infarction/ or *brain infarction size/ or *brain stem infarction/ or *cerebellum infarction/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*Carotid Artery Thrombosis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((brain or brainstem or cerebr* or cerebell* or vertebrobasil* or verte brobasil* or hemisphere* or intracran* or intracerebral or infratentorial or supratentorial or mca*1 or anterior circulation or carotid or transient or lacunar) adj3 (infarct* or thrombo* or emboli* or occlus* or hypoxi*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*brain ischemia/ or *hypoxic ischemic encephalopathy/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((brain or brainstem or cerebr* or cerebell* or vertebrobasil* or verte brobasil* or hemisphere* or intracran* or intracerebral or infratentorial or supratentorial or mca*1 or anterior circulation or carotid or crescendo or transient or lacunar) adj3 isch?emi*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*Transient ischemic attack/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(isch?emi* adj2 attack*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">TIA.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-15</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter.pt. or letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">note.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/ or case study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/17-21</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22 not 23</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal/ not human/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">nonhuman/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experiment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Experimental Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodent/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/24-31</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16 not 32</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(exp child/ or exp pediatrics/) not (exp adult/ or exp adolescent/)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33 not 34</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">health economics/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp economic evaluation/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp health care cost/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp fee/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">funding/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cost*.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(economic* or pharmaco?economic*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(price* or pricing*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cost* adj2 (effectiv* or utilit* or benefit* or minimi* or unit* or estimat* or variable*)).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(finance* or fee or fees).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(value adj2 (money or monetary)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/36-48</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35 and 49</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch4appbtab8"><div id="ch4.appb.tab8" class="table"><h3><span class="title">NHS EED and HTA (CRD) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577865/table/ch4.appb.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch4.appb.tab8_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR Stroke EXPLODE 1 2</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((stroke or strokes))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(((cerebro* or cerebral*) adj2 (accident* or apoplexy)))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((CVA or poststroke or poststrokes))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR Intracranial Hemorrhages EXPLODE ALL TREES</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((brain adj2 (attack*1 or hemorrhag* or haemorrhag* or bleed* or infarct*)))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(((intracerebral or intracranial or cerebral* or cerebro* or cerebrum or cerebellum or subarachnoid* or choroidal or basal ganglia or subdural) adj3 (hemorrhag* or haemorrhag* or bleed*)))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR Brain Infarction EXPLODE ALL TREES</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR Carotid Artery Thrombosis EXPLODE ALL TREES</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(((brain or brainstem or cerebr* or cerebell* or vertebrobasil* or verte brobasil* or hemisphere* or intracran* or intracerebral or infratentorial or supratentorial or mca*1 or anterior circulation or carotid or transient or lacunar) adj3 (infarct* or thrombo* or emboli* or occlus* or hypoxi*)))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR Brain Ischemia EXPLODE ALL TREES</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(((brain or brainstem or cerebr* or cerebell* or vertebrobasil* or verte brobasil* or hemisphere* or intracran* or intracerebral or infratentorial or supratentorial or mca*1 or anterior circulation or carotid or crescendo or transient or lacunar) adj3 isch?emi*))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR Ischemic Attack, Transient EXPLODE ALL TREES</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((isch?emi* adj2 attack*))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14</td></tr></tbody></table></div></div></article><article data-type="fig" id="figobch4appcfig1"><div id="ch4.appc.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%201.%20Flow%20chart%20of%20clinical%20study%20selection%20for%20the%20review%20of%20thrombectomy%20for%20anterior%20circulation%20stroke.&p=BOOKS&id=577865_ch4appcf1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577865/bin/ch4appcf1.jpg" alt="Figure 1. Flow chart of clinical study selection for the review of thrombectomy for anterior circulation stroke." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 1</span><span class="title">Flow chart of clinical study selection for the review of thrombectomy for anterior circulation stroke</span></h3></div></article><article data-type="fig" id="figobch4appcfig2"><div id="ch4.appc.fig2" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%202.%20Flow%20chart%20of%20clinical%20study%20selection%20for%20the%20additional%20search%20on%20thrombectomy%20for%20posterior%20circulatory%20stroke.&p=BOOKS&id=577865_ch4appcf2.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577865/bin/ch4appcf2.jpg" alt="Figure 2. Flow chart of clinical study selection for the additional search on thrombectomy for posterior circulatory stroke." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 2</span><span class="title">Flow chart of clinical study selection for the additional search on thrombectomy for posterior circulatory stroke</span></h3></div></article><article data-type="fig" id="figobch4appefig1"><div id="ch4.appe.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%203.%20Mortality%20at%2090%20days.&p=BOOKS&id=577865_ch4appef1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577865/bin/ch4appef1.jpg" alt="Figure 3. Mortality at 90 days." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 3</span><span class="title">Mortality at 90 days</span></h3></div></article><article data-type="fig" id="figobch4appefig2"><div id="ch4.appe.fig2" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%204.%20Mortality%20at%2090%20days.&p=BOOKS&id=577865_ch4appef2.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577865/bin/ch4appef2.jpg" alt="Figure 4. Mortality at 90 days." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 4</span><span class="title">Mortality at 90 days</span></h3></div></article><article data-type="fig" id="figobch4appefig3"><div id="ch4.appe.fig3" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%205.%20Mortality%20at%201%20year%20(thrombectomy%20up%20to%208%20hours).&p=BOOKS&id=577865_ch4appef3.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577865/bin/ch4appef3.jpg" alt="Figure 5. Mortality at 1 year (thrombectomy up to 8 hours)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 5</span><span class="title">Mortality at 1 year (thrombectomy up to 8 hours)</span></h3></div></article><article data-type="fig" id="figobch4appefig4"><div id="ch4.appe.fig4" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%206.%20Modified%20Rankin%20Scale%20(0%20-%202)%20at%2090%20days.&p=BOOKS&id=577865_ch4appef4.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577865/bin/ch4appef4.jpg" alt="Figure 6. Modified Rankin Scale (0 - 2) at 90 days." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 6</span><span class="title">Modified Rankin Scale (0 - 2) at 90 days</span></h3></div></article><article data-type="fig" id="figobch4appefig5"><div id="ch4.appe.fig5" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%207.%20Modified%20Rankin%20Scale%20(0%20-%202)%20at%201%20year%20(thrombectomy%20up%20to%208%20hours).&p=BOOKS&id=577865_ch4appef5.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577865/bin/ch4appef5.jpg" alt="Figure 7. Modified Rankin Scale (0 - 2) at 1 year (thrombectomy up to 8 hours)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 7</span><span class="title">Modified Rankin Scale (0 - 2) at 1 year (thrombectomy up to 8 hours)</span></h3></div></article><article data-type="fig" id="figobch4appefig6"><div id="ch4.appe.fig6" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%208.%20Modified%20Rankin%20Scale%20at%2090%20days%20(ordinal%20shift%20common%20odds%20ratios).&p=BOOKS&id=577865_ch4appef6.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577865/bin/ch4appef6.jpg" alt="Figure 8. Modified Rankin Scale at 90 days (ordinal shift common odds ratios)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 8</span><span class="title">Modified Rankin Scale at 90 days (ordinal shift common odds ratios)</span></h3></div></article><article data-type="fig" id="figobch4appefig7"><div id="ch4.appe.fig7" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%209.%20Modified%20Rankin%20Scale%20at%2090%20days%20(ordinal%20shift%20graphs).&p=BOOKS&id=577865_ch4appef7.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577865/bin/ch4appef7.jpg" alt="Figure 9. Modified Rankin Scale at 90 days (ordinal shift graphs)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 9</span><span class="title">Modified Rankin Scale at 90 days (ordinal shift graphs)</span></h3></div></article><article data-type="fig" id="figobch4appefig8"><div id="ch4.appe.fig8" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2010.%20Modified%20Rankin%20Scale%20at%201%20year%20(thrombectomy%20up%20to%208%20hours).&p=BOOKS&id=577865_ch4appef8.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577865/bin/ch4appef8.jpg" alt="Figure 10. Modified Rankin Scale at 1 year (thrombectomy up to 8 hours)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 10</span><span class="title">Modified Rankin Scale at 1 year (thrombectomy up to 8 hours)</span></h3></div></article><article data-type="fig" id="figobch4appefig9"><div id="ch4.appe.fig9" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2011.%20Symptomatic%20intracranial%20haemorrhage%20at%2090%20days.&p=BOOKS&id=577865_ch4appef9.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577865/bin/ch4appef9.jpg" alt="Figure 11. Symptomatic intracranial haemorrhage at 90 days." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 11</span><span class="title">Symptomatic intracranial haemorrhage at 90 days</span></h3></div></article><article data-type="fig" id="figobch4appefig10"><div id="ch4.appe.fig10" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2012.%20Intracerebral%20haemorrhage%20at%2090%20days%20(thrombectomy%20up%20to%206%20hours).&p=BOOKS&id=577865_ch4appef10.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577865/bin/ch4appef10.jpg" alt="Figure 12. Intracerebral haemorrhage at 90 days (thrombectomy up to 6 hours)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 12</span><span class="title">Intracerebral haemorrhage at 90 days (thrombectomy up to 6 hours)</span></h3></div></article><article data-type="fig" id="figobch4appefig11"><div id="ch4.appe.fig11" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2013.%20Recurrent%20stroke%20at%2090%20days%20(thrombectomy%20up%20to%208%20hours).&p=BOOKS&id=577865_ch4appef11.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577865/bin/ch4appef11.jpg" alt="Figure 13. Recurrent stroke at 90 days (thrombectomy up to 8 hours)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 13</span><span class="title">Recurrent stroke at 90 days (thrombectomy up to 8 hours)</span></h3></div></article><article data-type="fig" id="figobch4appefig12"><div id="ch4.appe.fig12" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2014.%20Malignant%20middle%20cerebral%20artery%20syndrome%20at%2090%20days%20(thrombectomy%20up%20to%2012%20hours).&p=BOOKS&id=577865_ch4appef12.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577865/bin/ch4appef12.jpg" alt="Figure 14. Malignant middle cerebral artery syndrome at 90 days (thrombectomy up to 12 hours)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 14</span><span class="title">Malignant middle cerebral artery syndrome at 90 days (thrombectomy up to 12 hours)</span></h3></div></article><article data-type="fig" id="figobch4appefig13"><div id="ch4.appe.fig13" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2015.%20Any%20serious%20adverse%20event%20at%2090%20days%20(thrombectomy%20up%20to%206%20hours).&p=BOOKS&id=577865_ch4appef13.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577865/bin/ch4appef13.jpg" alt="Figure 15. Any serious adverse event at 90 days (thrombectomy up to 6 hours)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 15</span><span class="title">Any serious adverse event at 90 days (thrombectomy up to 6 hours)</span></h3></div></article><article data-type="fig" id="figobch4appefig14"><div id="ch4.appe.fig14" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2016.%20Procedural%20complications%20(thrombectomy%206-24%20hours).&p=BOOKS&id=577865_ch4appef14.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577865/bin/ch4appef14.jpg" alt="Figure 16. Procedural complications (thrombectomy 6-24 hours)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 16</span><span class="title">Procedural complications (thrombectomy 6-24 hours)</span></h3></div></article><article data-type="fig" id="figobch4appefig15"><div id="ch4.appe.fig15" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2017.%20EQ-5D%20at%2090%20days%20(thrombectomy%20up%20to%206%20hours).&p=BOOKS&id=577865_ch4appef15.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577865/bin/ch4appef15.jpg" alt="Figure 17. EQ-5D at 90 days (thrombectomy up to 6 hours)." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 17</span><span class="title">EQ-5D at 90 days (thrombectomy up to 6 hours)</span></h3></div></article><article data-type="table-wrap" id="figobch4appftab1"><div id="ch4.appf.tab1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577865/table/ch4.appf.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch4.appf.tab1_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch4.appf.tab1_1_1_1_1" colspan="7" rowspan="1" style="text-align:center;vertical-align:middle;">Quality assessment</th><th id="hd_h_ch4.appf.tab1_1_1_1_2" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">No of patients</th><th id="hd_h_ch4.appf.tab1_1_1_1_3" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">Effect</th><th id="hd_h_ch4.appf.tab1_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_ch4.appf.tab1_1_1_1_4" style="text-align:center;vertical-align:middle;">Quality</th><th id="hd_h_ch4.appf.tab1_1_1_1_5" rowspan="2" colspan="1" headers="hd_h_ch4.appf.tab1_1_1_1_5" style="text-align:center;vertical-align:middle;">Importance</th></tr><tr><th headers="hd_h_ch4.appf.tab1_1_1_1_1" id="hd_h_ch4.appf.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">No of studies</th><th headers="hd_h_ch4.appf.tab1_1_1_1_1" id="hd_h_ch4.appf.tab1_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Design</th><th headers="hd_h_ch4.appf.tab1_1_1_1_1" id="hd_h_ch4.appf.tab1_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk of bias</th><th headers="hd_h_ch4.appf.tab1_1_1_1_1" id="hd_h_ch4.appf.tab1_1_1_2_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Inconsistency</th><th headers="hd_h_ch4.appf.tab1_1_1_1_1" id="hd_h_ch4.appf.tab1_1_1_2_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Indirectness</th><th headers="hd_h_ch4.appf.tab1_1_1_1_1" id="hd_h_ch4.appf.tab1_1_1_2_6" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Imprecision</th><th headers="hd_h_ch4.appf.tab1_1_1_1_1" id="hd_h_ch4.appf.tab1_1_1_2_7" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Other considerations</th><th headers="hd_h_ch4.appf.tab1_1_1_1_2" id="hd_h_ch4.appf.tab1_1_1_2_8" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Thrombectomy plus medical management</th><th headers="hd_h_ch4.appf.tab1_1_1_1_2" id="hd_h_ch4.appf.tab1_1_1_2_9" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Control</th><th headers="hd_h_ch4.appf.tab1_1_1_1_3" id="hd_h_ch4.appf.tab1_1_1_2_10" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Relative (95% CI)</th><th headers="hd_h_ch4.appf.tab1_1_1_1_3" id="hd_h_ch4.appf.tab1_1_1_2_11" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Absolute</th></tr></thead><tbody><tr><th headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_1 hd_h_ch4.appf.tab1_1_1_2_2 hd_h_ch4.appf.tab1_1_1_2_3 hd_h_ch4.appf.tab1_1_1_2_4 hd_h_ch4.appf.tab1_1_1_2_5 hd_h_ch4.appf.tab1_1_1_2_6 hd_h_ch4.appf.tab1_1_1_2_7 hd_h_ch4.appf.tab1_1_1_1_2 hd_h_ch4.appf.tab1_1_1_2_8 hd_h_ch4.appf.tab1_1_1_2_9 hd_h_ch4.appf.tab1_1_1_1_3 hd_h_ch4.appf.tab1_1_1_2_10 hd_h_ch4.appf.tab1_1_1_2_11 hd_h_ch4.appf.tab1_1_1_1_4 hd_h_ch4.appf.tab1_1_1_1_5" id="hd_b_ch4.appf.tab1_1_1_1_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Mortality at 90 days</th></tr><tr><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_1 hd_b_ch4.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_2 hd_b_ch4.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_3 hd_b_ch4.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious risk of bias</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_4 hd_b_ch4.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_5 hd_b_ch4.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_6 hd_b_ch4.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>1</sup></td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_7 hd_b_ch4.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch4.appf.tab1_1_1_1_2 hd_h_ch4.appf.tab1_1_1_2_8 hd_b_ch4.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
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<p>93/650</p>
|
|
<p>(14.3%)</p>
|
|
</td><td headers="hd_h_ch4.appf.tab1_1_1_1_2 hd_h_ch4.appf.tab1_1_1_2_9 hd_b_ch4.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">15.7%</td><td headers="hd_h_ch4.appf.tab1_1_1_1_3 hd_h_ch4.appf.tab1_1_1_2_10 hd_b_ch4.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 0.9 (0.7 to 1.16)</td><td headers="hd_h_ch4.appf.tab1_1_1_1_3 hd_h_ch4.appf.tab1_1_1_2_11 hd_b_ch4.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">16 fewer per 1000 (from 47 fewer to 25 more)</td><td headers="hd_h_ch4.appf.tab1_1_1_1_4 hd_b_ch4.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>⨁⨁⨁◯</p>
|
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<p>MODERATE</p>
|
|
</td><td headers="hd_h_ch4.appf.tab1_1_1_1_5 hd_b_ch4.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_1 hd_h_ch4.appf.tab1_1_1_2_2 hd_h_ch4.appf.tab1_1_1_2_3 hd_h_ch4.appf.tab1_1_1_2_4 hd_h_ch4.appf.tab1_1_1_2_5 hd_h_ch4.appf.tab1_1_1_2_6 hd_h_ch4.appf.tab1_1_1_2_7 hd_h_ch4.appf.tab1_1_1_1_2 hd_h_ch4.appf.tab1_1_1_2_8 hd_h_ch4.appf.tab1_1_1_2_9 hd_h_ch4.appf.tab1_1_1_1_3 hd_h_ch4.appf.tab1_1_1_2_10 hd_h_ch4.appf.tab1_1_1_2_11 hd_h_ch4.appf.tab1_1_1_1_4 hd_h_ch4.appf.tab1_1_1_1_5" id="hd_b_ch4.appf.tab1_1_1_3_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Modified Rankin Scale (0 - 2) 90 days</th></tr><tr><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_1 hd_b_ch4.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_2 hd_b_ch4.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_3 hd_b_ch4.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>2</sup></td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_4 hd_b_ch4.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_5 hd_b_ch4.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_6 hd_b_ch4.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_7 hd_b_ch4.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch4.appf.tab1_1_1_1_2 hd_h_ch4.appf.tab1_1_1_2_8 hd_b_ch4.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
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<p>302/649</p>
|
|
<p>(46.5%)</p>
|
|
</td><td headers="hd_h_ch4.appf.tab1_1_1_1_2 hd_h_ch4.appf.tab1_1_1_2_9 hd_b_ch4.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">37.7%</td><td headers="hd_h_ch4.appf.tab1_1_1_1_3 hd_h_ch4.appf.tab1_1_1_2_10 hd_b_ch4.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 1.47 (1.28 to 1.68)</td><td headers="hd_h_ch4.appf.tab1_1_1_1_3 hd_h_ch4.appf.tab1_1_1_2_11 hd_b_ch4.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">177 more per 1000 (from 106 more to 256 more)</td><td headers="hd_h_ch4.appf.tab1_1_1_1_4 hd_b_ch4.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
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<p>⨁⨁⨁◯</p>
|
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<p>MODERATE</p>
|
|
</td><td headers="hd_h_ch4.appf.tab1_1_1_1_5 hd_b_ch4.appf.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_1 hd_h_ch4.appf.tab1_1_1_2_2 hd_h_ch4.appf.tab1_1_1_2_3 hd_h_ch4.appf.tab1_1_1_2_4 hd_h_ch4.appf.tab1_1_1_2_5 hd_h_ch4.appf.tab1_1_1_2_6 hd_h_ch4.appf.tab1_1_1_2_7 hd_h_ch4.appf.tab1_1_1_1_2 hd_h_ch4.appf.tab1_1_1_2_8 hd_h_ch4.appf.tab1_1_1_2_9 hd_h_ch4.appf.tab1_1_1_1_3 hd_h_ch4.appf.tab1_1_1_2_10 hd_h_ch4.appf.tab1_1_1_2_11 hd_h_ch4.appf.tab1_1_1_1_4 hd_h_ch4.appf.tab1_1_1_1_5" id="hd_b_ch4.appf.tab1_1_1_5_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Modified Rankin Scale at 90 days (Better indicated by higher values)</th></tr><tr><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_1 hd_b_ch4.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_2 hd_b_ch4.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_3 hd_b_ch4.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>2</sup></td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_4 hd_b_ch4.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_5 hd_b_ch4.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_6 hd_b_ch4.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_7 hd_b_ch4.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch4.appf.tab1_1_1_1_2 hd_h_ch4.appf.tab1_1_1_2_8 hd_b_ch4.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">649</td><td headers="hd_h_ch4.appf.tab1_1_1_1_2 hd_h_ch4.appf.tab1_1_1_2_9 hd_b_ch4.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">675</td><td headers="hd_h_ch4.appf.tab1_1_1_1_3 hd_h_ch4.appf.tab1_1_1_2_10 hd_b_ch4.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Common OR 1.78 (1.47 to 2.16)<sup>3</sup></td><td headers="hd_h_ch4.appf.tab1_1_1_1_3 hd_h_ch4.appf.tab1_1_1_2_11 hd_b_ch4.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_ch4.appf.tab1_1_1_1_4 hd_b_ch4.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>⨁⨁⨁◯</p>
|
|
<p>MODERATE</p>
|
|
</td><td headers="hd_h_ch4.appf.tab1_1_1_1_5 hd_b_ch4.appf.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_1 hd_h_ch4.appf.tab1_1_1_2_2 hd_h_ch4.appf.tab1_1_1_2_3 hd_h_ch4.appf.tab1_1_1_2_4 hd_h_ch4.appf.tab1_1_1_2_5 hd_h_ch4.appf.tab1_1_1_2_6 hd_h_ch4.appf.tab1_1_1_2_7 hd_h_ch4.appf.tab1_1_1_1_2 hd_h_ch4.appf.tab1_1_1_2_8 hd_h_ch4.appf.tab1_1_1_2_9 hd_h_ch4.appf.tab1_1_1_1_3 hd_h_ch4.appf.tab1_1_1_2_10 hd_h_ch4.appf.tab1_1_1_2_11 hd_h_ch4.appf.tab1_1_1_1_4 hd_h_ch4.appf.tab1_1_1_1_5" id="hd_b_ch4.appf.tab1_1_1_7_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Symptomatic intracranial haemorrhage at 90 days</th></tr><tr><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_1 hd_b_ch4.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_2 hd_b_ch4.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_3 hd_b_ch4.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious risk of bias</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_4 hd_b_ch4.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_5 hd_b_ch4.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_6 hd_b_ch4.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>1</sup></td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_7 hd_b_ch4.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch4.appf.tab1_1_1_1_2 hd_h_ch4.appf.tab1_1_1_2_8 hd_b_ch4.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>26/627</p>
|
|
<p>(4.1%)</p>
|
|
</td><td headers="hd_h_ch4.appf.tab1_1_1_1_2 hd_h_ch4.appf.tab1_1_1_2_9 hd_b_ch4.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">4.4%</td><td headers="hd_h_ch4.appf.tab1_1_1_1_3 hd_h_ch4.appf.tab1_1_1_2_10 hd_b_ch4.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 0.98 (0.6 to 1.6)</td><td headers="hd_h_ch4.appf.tab1_1_1_1_3 hd_h_ch4.appf.tab1_1_1_2_11 hd_b_ch4.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">1 fewer per 1000 (from 18 fewer to 26 more)</td><td headers="hd_h_ch4.appf.tab1_1_1_1_4 hd_b_ch4.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>⨁⨁◯◯</p>
|
|
<p>LOW</p>
|
|
</td><td headers="hd_h_ch4.appf.tab1_1_1_1_5 hd_b_ch4.appf.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IMPORTANT</td></tr><tr><th headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_1 hd_h_ch4.appf.tab1_1_1_2_2 hd_h_ch4.appf.tab1_1_1_2_3 hd_h_ch4.appf.tab1_1_1_2_4 hd_h_ch4.appf.tab1_1_1_2_5 hd_h_ch4.appf.tab1_1_1_2_6 hd_h_ch4.appf.tab1_1_1_2_7 hd_h_ch4.appf.tab1_1_1_1_2 hd_h_ch4.appf.tab1_1_1_2_8 hd_h_ch4.appf.tab1_1_1_2_9 hd_h_ch4.appf.tab1_1_1_1_3 hd_h_ch4.appf.tab1_1_1_2_10 hd_h_ch4.appf.tab1_1_1_2_11 hd_h_ch4.appf.tab1_1_1_1_4 hd_h_ch4.appf.tab1_1_1_1_5" id="hd_b_ch4.appf.tab1_1_1_9_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Intracerebral haemorrhage</th></tr><tr><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_1 hd_b_ch4.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_2 hd_b_ch4.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_3 hd_b_ch4.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious risk of bias</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_4 hd_b_ch4.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_5 hd_b_ch4.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_6 hd_b_ch4.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>1</sup></td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_7 hd_b_ch4.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch4.appf.tab1_1_1_1_2 hd_h_ch4.appf.tab1_1_1_2_8 hd_b_ch4.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>3/33</p>
|
|
<p>(9.1%)</p>
|
|
</td><td headers="hd_h_ch4.appf.tab1_1_1_1_2 hd_h_ch4.appf.tab1_1_1_2_9 hd_b_ch4.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">9.4%</td><td headers="hd_h_ch4.appf.tab1_1_1_1_3 hd_h_ch4.appf.tab1_1_1_2_10 hd_b_ch4.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>RR 0.97 (0.21 to 4.45)</p>
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|
</td><td headers="hd_h_ch4.appf.tab1_1_1_1_3 hd_h_ch4.appf.tab1_1_1_2_11 hd_b_ch4.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">3 fewer per 1000 (from 74 fewer to 324 more)</td><td headers="hd_h_ch4.appf.tab1_1_1_1_4 hd_b_ch4.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>⨁⨁◯◯</p>
|
|
<p>LOW</p>
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|
</td><td headers="hd_h_ch4.appf.tab1_1_1_1_5 hd_b_ch4.appf.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IMPORTANT</td></tr><tr><th headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_1 hd_h_ch4.appf.tab1_1_1_2_2 hd_h_ch4.appf.tab1_1_1_2_3 hd_h_ch4.appf.tab1_1_1_2_4 hd_h_ch4.appf.tab1_1_1_2_5 hd_h_ch4.appf.tab1_1_1_2_6 hd_h_ch4.appf.tab1_1_1_2_7 hd_h_ch4.appf.tab1_1_1_1_2 hd_h_ch4.appf.tab1_1_1_2_8 hd_h_ch4.appf.tab1_1_1_2_9 hd_h_ch4.appf.tab1_1_1_1_3 hd_h_ch4.appf.tab1_1_1_2_10 hd_h_ch4.appf.tab1_1_1_2_11 hd_h_ch4.appf.tab1_1_1_1_4 hd_h_ch4.appf.tab1_1_1_1_5" id="hd_b_ch4.appf.tab1_1_1_11_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Any serious adverse event at 90 days</th></tr><tr><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_1 hd_b_ch4.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_2 hd_b_ch4.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_3 hd_b_ch4.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious risk of bias</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_4 hd_b_ch4.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_5 hd_b_ch4.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_6 hd_b_ch4.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>1</sup></td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_7 hd_b_ch4.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch4.appf.tab1_1_1_1_2 hd_h_ch4.appf.tab1_1_1_2_8 hd_b_ch4.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>163/374</p>
|
|
<p>(43.6%)</p>
|
|
</td><td headers="hd_h_ch4.appf.tab1_1_1_1_2 hd_h_ch4.appf.tab1_1_1_2_9 hd_b_ch4.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">42.3%</td><td headers="hd_h_ch4.appf.tab1_1_1_1_3 hd_h_ch4.appf.tab1_1_1_2_10 hd_b_ch4.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>RR 1.08 (0.92 to 1.28)</p>
|
|
</td><td headers="hd_h_ch4.appf.tab1_1_1_1_3 hd_h_ch4.appf.tab1_1_1_2_11 hd_b_ch4.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">34 more per 1000 (from 34 fewer to 118 more)</td><td headers="hd_h_ch4.appf.tab1_1_1_1_4 hd_b_ch4.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>⨁⨁⨁◯</p>
|
|
<p>MODERATE</p>
|
|
</td><td headers="hd_h_ch4.appf.tab1_1_1_1_5 hd_b_ch4.appf.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IMPORTANT</td></tr><tr><th headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_1 hd_h_ch4.appf.tab1_1_1_2_2 hd_h_ch4.appf.tab1_1_1_2_3 hd_h_ch4.appf.tab1_1_1_2_4 hd_h_ch4.appf.tab1_1_1_2_5 hd_h_ch4.appf.tab1_1_1_2_6 hd_h_ch4.appf.tab1_1_1_2_7 hd_h_ch4.appf.tab1_1_1_1_2 hd_h_ch4.appf.tab1_1_1_2_8 hd_h_ch4.appf.tab1_1_1_2_9 hd_h_ch4.appf.tab1_1_1_1_3 hd_h_ch4.appf.tab1_1_1_2_10 hd_h_ch4.appf.tab1_1_1_2_11 hd_h_ch4.appf.tab1_1_1_1_4 hd_h_ch4.appf.tab1_1_1_1_5" id="hd_b_ch4.appf.tab1_1_1_13_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">EQ-5D at 90 days (Better indicated by higher values)</th></tr><tr><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_1 hd_b_ch4.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_2 hd_b_ch4.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_3 hd_b_ch4.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>2</sup></td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_4 hd_b_ch4.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_5 hd_b_ch4.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_6 hd_b_ch4.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_7 hd_b_ch4.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch4.appf.tab1_1_1_1_2 hd_h_ch4.appf.tab1_1_1_2_8 hd_b_ch4.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">130</td><td headers="hd_h_ch4.appf.tab1_1_1_1_2 hd_h_ch4.appf.tab1_1_1_2_9 hd_b_ch4.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">130</td><td headers="hd_h_ch4.appf.tab1_1_1_1_3 hd_h_ch4.appf.tab1_1_1_2_10 hd_b_ch4.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_ch4.appf.tab1_1_1_1_3 hd_h_ch4.appf.tab1_1_1_2_11 hd_b_ch4.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 0.02 higher (0.08 lower to 0.11 higher)</td><td headers="hd_h_ch4.appf.tab1_1_1_1_4 hd_b_ch4.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>⨁⨁⨁◯</p>
|
|
<p>MODERATE</p>
|
|
</td><td headers="hd_h_ch4.appf.tab1_1_1_1_5 hd_b_ch4.appf.tab1_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IMPORTANT</td></tr><tr><th headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_1 hd_h_ch4.appf.tab1_1_1_2_2 hd_h_ch4.appf.tab1_1_1_2_3 hd_h_ch4.appf.tab1_1_1_2_4 hd_h_ch4.appf.tab1_1_1_2_5 hd_h_ch4.appf.tab1_1_1_2_6 hd_h_ch4.appf.tab1_1_1_2_7 hd_h_ch4.appf.tab1_1_1_1_2 hd_h_ch4.appf.tab1_1_1_2_8 hd_h_ch4.appf.tab1_1_1_2_9 hd_h_ch4.appf.tab1_1_1_1_3 hd_h_ch4.appf.tab1_1_1_2_10 hd_h_ch4.appf.tab1_1_1_2_11 hd_h_ch4.appf.tab1_1_1_1_4 hd_h_ch4.appf.tab1_1_1_1_5" id="hd_b_ch4.appf.tab1_1_1_15_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">EQ-5D at 90 days (Better indicated by higher values)</th></tr><tr><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_1 hd_b_ch4.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_2 hd_b_ch4.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_3 hd_b_ch4.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>2</sup></td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_4 hd_b_ch4.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_5 hd_b_ch4.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_6 hd_b_ch4.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision<sup>5</sup></td><td headers="hd_h_ch4.appf.tab1_1_1_1_1 hd_h_ch4.appf.tab1_1_1_2_7 hd_b_ch4.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch4.appf.tab1_1_1_1_2 hd_h_ch4.appf.tab1_1_1_2_8 hd_b_ch4.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">233</td><td headers="hd_h_ch4.appf.tab1_1_1_1_2 hd_h_ch4.appf.tab1_1_1_2_9 hd_b_ch4.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">267</td><td headers="hd_h_ch4.appf.tab1_1_1_1_3 hd_h_ch4.appf.tab1_1_1_2_10 hd_b_ch4.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;"></td><td headers="hd_h_ch4.appf.tab1_1_1_1_3 hd_h_ch4.appf.tab1_1_1_2_11 hd_b_ch4.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">The median EQ-5D at 90 days in the intervention group was 0.03 higher</td><td headers="hd_h_ch4.appf.tab1_1_1_1_4 hd_b_ch4.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>⨁⨁⨁◯</p>
|
|
<p>MODERATE</p>
|
|
</td><td headers="hd_h_ch4.appf.tab1_1_1_1_5 hd_b_ch4.appf.tab1_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IMPORTANT</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="ch4.appf.tab1_1"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed 1 MID or by 2 increments if the confidence interval crossed both MIDs</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="ch4.appf.tab1_2"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="ch4.appf.tab1_3"><p class="no_margin">One study provided an odds ratio adjusted for age, NIHSS at baseline, time from stroke onset to randomisation, prior stroke, atrial fibrillation, diabetes mellitus and internal carotid artery terminus occlusion; the second study (23.8% weight) was an unadjusted estimate.</p></div></dd></dl><dl class="bkr_refwrap"><dt>4</dt><dd><div id="ch4.appf.tab1_4"><p class="no_margin">Adjusted for age, NIHSS at baseline, time from stroke onset to randomisation, prior stroke, atrial fibrillation, diabetes mellitus and internal carotid artery terminus occlusion.</p></div></dd></dl><dl class="bkr_refwrap"><dt>5</dt><dd><div id="ch4.appf.tab1_5"><p class="no_margin">Imprecision could not be assessed because non-parametric statistics were reported.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch4appftab2"><div id="ch4.appf.tab2" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577865/table/ch4.appf.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch4.appf.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch4.appf.tab2_1_1_1_1" colspan="7" rowspan="1" style="text-align:center;vertical-align:middle;">Quality assessment</th><th id="hd_h_ch4.appf.tab2_1_1_1_2" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">No of patients</th><th id="hd_h_ch4.appf.tab2_1_1_1_3" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">Effect</th><th id="hd_h_ch4.appf.tab2_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_ch4.appf.tab2_1_1_1_4" style="text-align:center;vertical-align:middle;">Quality</th><th id="hd_h_ch4.appf.tab2_1_1_1_5" rowspan="2" colspan="1" headers="hd_h_ch4.appf.tab2_1_1_1_5" style="text-align:center;vertical-align:middle;">Importance</th></tr><tr><th headers="hd_h_ch4.appf.tab2_1_1_1_1" id="hd_h_ch4.appf.tab2_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">No of studies</th><th headers="hd_h_ch4.appf.tab2_1_1_1_1" id="hd_h_ch4.appf.tab2_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Design</th><th headers="hd_h_ch4.appf.tab2_1_1_1_1" id="hd_h_ch4.appf.tab2_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk of bias</th><th headers="hd_h_ch4.appf.tab2_1_1_1_1" id="hd_h_ch4.appf.tab2_1_1_2_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Inconsistency</th><th headers="hd_h_ch4.appf.tab2_1_1_1_1" id="hd_h_ch4.appf.tab2_1_1_2_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Indirectness</th><th headers="hd_h_ch4.appf.tab2_1_1_1_1" id="hd_h_ch4.appf.tab2_1_1_2_6" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Imprecision</th><th headers="hd_h_ch4.appf.tab2_1_1_1_1" id="hd_h_ch4.appf.tab2_1_1_2_7" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Other considerations</th><th headers="hd_h_ch4.appf.tab2_1_1_1_2" id="hd_h_ch4.appf.tab2_1_1_2_8" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Thrombectomy plus medical management</th><th headers="hd_h_ch4.appf.tab2_1_1_1_2" id="hd_h_ch4.appf.tab2_1_1_2_9" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Control</th><th headers="hd_h_ch4.appf.tab2_1_1_1_3" id="hd_h_ch4.appf.tab2_1_1_2_10" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Relative (95% CI)</th><th headers="hd_h_ch4.appf.tab2_1_1_1_3" id="hd_h_ch4.appf.tab2_1_1_2_11" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Absolute</th></tr></thead><tbody><tr><th headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_1 hd_h_ch4.appf.tab2_1_1_2_2 hd_h_ch4.appf.tab2_1_1_2_3 hd_h_ch4.appf.tab2_1_1_2_4 hd_h_ch4.appf.tab2_1_1_2_5 hd_h_ch4.appf.tab2_1_1_2_6 hd_h_ch4.appf.tab2_1_1_2_7 hd_h_ch4.appf.tab2_1_1_1_2 hd_h_ch4.appf.tab2_1_1_2_8 hd_h_ch4.appf.tab2_1_1_2_9 hd_h_ch4.appf.tab2_1_1_1_3 hd_h_ch4.appf.tab2_1_1_2_10 hd_h_ch4.appf.tab2_1_1_2_11 hd_h_ch4.appf.tab2_1_1_1_4 hd_h_ch4.appf.tab2_1_1_1_5" id="hd_b_ch4.appf.tab2_1_1_1_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Mortality at 90 days</th></tr><tr><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_1 hd_b_ch4.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_2 hd_b_ch4.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_3 hd_b_ch4.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious risk of bias</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_4 hd_b_ch4.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_5 hd_b_ch4.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_6 hd_b_ch4.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>1</sup></td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_7 hd_b_ch4.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch4.appf.tab2_1_1_1_2 hd_h_ch4.appf.tab2_1_1_2_8 hd_b_ch4.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>19/103</p>
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<p>(18.4%)</p>
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</td><td headers="hd_h_ch4.appf.tab2_1_1_1_2 hd_h_ch4.appf.tab2_1_1_2_9 hd_b_ch4.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">15.5%</td><td headers="hd_h_ch4.appf.tab2_1_1_1_3 hd_h_ch4.appf.tab2_1_1_2_10 hd_b_ch4.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 1.19 (0.65 to 2.18)</td><td headers="hd_h_ch4.appf.tab2_1_1_1_3 hd_h_ch4.appf.tab2_1_1_2_11 hd_b_ch4.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">29 more per 1000 (from 54 fewer to 183 more)</td><td headers="hd_h_ch4.appf.tab2_1_1_1_4 hd_b_ch4.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⨁⨁◯◯</p>
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<p>LOW</p>
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</td><td headers="hd_h_ch4.appf.tab2_1_1_1_5 hd_b_ch4.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_1 hd_h_ch4.appf.tab2_1_1_2_2 hd_h_ch4.appf.tab2_1_1_2_3 hd_h_ch4.appf.tab2_1_1_2_4 hd_h_ch4.appf.tab2_1_1_2_5 hd_h_ch4.appf.tab2_1_1_2_6 hd_h_ch4.appf.tab2_1_1_2_7 hd_h_ch4.appf.tab2_1_1_1_2 hd_h_ch4.appf.tab2_1_1_2_8 hd_h_ch4.appf.tab2_1_1_2_9 hd_h_ch4.appf.tab2_1_1_1_3 hd_h_ch4.appf.tab2_1_1_2_10 hd_h_ch4.appf.tab2_1_1_2_11 hd_h_ch4.appf.tab2_1_1_1_4 hd_h_ch4.appf.tab2_1_1_1_5" id="hd_b_ch4.appf.tab2_1_1_3_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Mortality at 12 months</th></tr><tr><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_1 hd_b_ch4.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_2 hd_b_ch4.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_3 hd_b_ch4.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious risk of bias</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_4 hd_b_ch4.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_5 hd_b_ch4.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_6 hd_b_ch4.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>1</sup></td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_7 hd_b_ch4.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch4.appf.tab2_1_1_1_2 hd_h_ch4.appf.tab2_1_1_2_8 hd_b_ch4.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>24/103</p>
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<p>(23.3%)</p>
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</td><td headers="hd_h_ch4.appf.tab2_1_1_1_2 hd_h_ch4.appf.tab2_1_1_2_9 hd_b_ch4.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">24.3%</td><td headers="hd_h_ch4.appf.tab2_1_1_1_3 hd_h_ch4.appf.tab2_1_1_2_10 hd_b_ch4.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 0.96 (0.59 to 1.57)</td><td headers="hd_h_ch4.appf.tab2_1_1_1_3 hd_h_ch4.appf.tab2_1_1_2_11 hd_b_ch4.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">10 fewer per 1000 (from 100 fewer to 139 more)</td><td headers="hd_h_ch4.appf.tab2_1_1_1_4 hd_b_ch4.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⨁⨁◯◯</p>
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<p>LOW</p>
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</td><td headers="hd_h_ch4.appf.tab2_1_1_1_5 hd_b_ch4.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_1 hd_h_ch4.appf.tab2_1_1_2_2 hd_h_ch4.appf.tab2_1_1_2_3 hd_h_ch4.appf.tab2_1_1_2_4 hd_h_ch4.appf.tab2_1_1_2_5 hd_h_ch4.appf.tab2_1_1_2_6 hd_h_ch4.appf.tab2_1_1_2_7 hd_h_ch4.appf.tab2_1_1_1_2 hd_h_ch4.appf.tab2_1_1_2_8 hd_h_ch4.appf.tab2_1_1_2_9 hd_h_ch4.appf.tab2_1_1_1_3 hd_h_ch4.appf.tab2_1_1_2_10 hd_h_ch4.appf.tab2_1_1_2_11 hd_h_ch4.appf.tab2_1_1_1_4 hd_h_ch4.appf.tab2_1_1_1_5" id="hd_b_ch4.appf.tab2_1_1_5_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Modified Rankin Scale (0 - 2) 90 days</th></tr><tr><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_1 hd_b_ch4.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_2 hd_b_ch4.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_3 hd_b_ch4.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>2</sup></td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_4 hd_b_ch4.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_5 hd_b_ch4.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_6 hd_b_ch4.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>1</sup></td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_7 hd_b_ch4.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch4.appf.tab2_1_1_1_2 hd_h_ch4.appf.tab2_1_1_2_8 hd_b_ch4.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>45/103</p>
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<p>(43.7%)</p>
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</td><td headers="hd_h_ch4.appf.tab2_1_1_1_2 hd_h_ch4.appf.tab2_1_1_2_9 hd_b_ch4.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">28.2%</td><td headers="hd_h_ch4.appf.tab2_1_1_1_3 hd_h_ch4.appf.tab2_1_1_2_10 hd_b_ch4.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 1.55 (1.06 to 2.27)</td><td headers="hd_h_ch4.appf.tab2_1_1_1_3 hd_h_ch4.appf.tab2_1_1_2_11 hd_b_ch4.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">155 more per 1000 (from 17 more to 358 more)</td><td headers="hd_h_ch4.appf.tab2_1_1_1_4 hd_b_ch4.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⨁⨁◯◯</p>
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<p>LOW</p>
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</td><td headers="hd_h_ch4.appf.tab2_1_1_1_5 hd_b_ch4.appf.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_1 hd_h_ch4.appf.tab2_1_1_2_2 hd_h_ch4.appf.tab2_1_1_2_3 hd_h_ch4.appf.tab2_1_1_2_4 hd_h_ch4.appf.tab2_1_1_2_5 hd_h_ch4.appf.tab2_1_1_2_6 hd_h_ch4.appf.tab2_1_1_2_7 hd_h_ch4.appf.tab2_1_1_1_2 hd_h_ch4.appf.tab2_1_1_2_8 hd_h_ch4.appf.tab2_1_1_2_9 hd_h_ch4.appf.tab2_1_1_1_3 hd_h_ch4.appf.tab2_1_1_2_10 hd_h_ch4.appf.tab2_1_1_2_11 hd_h_ch4.appf.tab2_1_1_1_4 hd_h_ch4.appf.tab2_1_1_1_5" id="hd_b_ch4.appf.tab2_1_1_7_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Modified Rankin Scale (0 - 2) at 1 year</th></tr><tr><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_1 hd_b_ch4.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_2 hd_b_ch4.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_3 hd_b_ch4.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>2</sup></td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_4 hd_b_ch4.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_5 hd_b_ch4.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_6 hd_b_ch4.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>1</sup></td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_7 hd_b_ch4.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch4.appf.tab2_1_1_1_2 hd_h_ch4.appf.tab2_1_1_2_8 hd_b_ch4.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>45/103</p>
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<p>(43.7%)</p>
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</td><td headers="hd_h_ch4.appf.tab2_1_1_1_2 hd_h_ch4.appf.tab2_1_1_2_9 hd_b_ch4.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">30.1%</td><td headers="hd_h_ch4.appf.tab2_1_1_1_3 hd_h_ch4.appf.tab2_1_1_2_10 hd_b_ch4.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 1.45 (1.01 to 2.1)</td><td headers="hd_h_ch4.appf.tab2_1_1_1_3 hd_h_ch4.appf.tab2_1_1_2_11 hd_b_ch4.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">135 more per 1000 (from 3 more to 331 more)</td><td headers="hd_h_ch4.appf.tab2_1_1_1_4 hd_b_ch4.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
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<p>⨁⨁◯◯</p>
|
|
<p>LOW</p>
|
|
</td><td headers="hd_h_ch4.appf.tab2_1_1_1_5 hd_b_ch4.appf.tab2_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_1 hd_h_ch4.appf.tab2_1_1_2_2 hd_h_ch4.appf.tab2_1_1_2_3 hd_h_ch4.appf.tab2_1_1_2_4 hd_h_ch4.appf.tab2_1_1_2_5 hd_h_ch4.appf.tab2_1_1_2_6 hd_h_ch4.appf.tab2_1_1_2_7 hd_h_ch4.appf.tab2_1_1_1_2 hd_h_ch4.appf.tab2_1_1_2_8 hd_h_ch4.appf.tab2_1_1_2_9 hd_h_ch4.appf.tab2_1_1_1_3 hd_h_ch4.appf.tab2_1_1_2_10 hd_h_ch4.appf.tab2_1_1_2_11 hd_h_ch4.appf.tab2_1_1_1_4 hd_h_ch4.appf.tab2_1_1_1_5" id="hd_b_ch4.appf.tab2_1_1_9_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Modified Rankin Scale at 90 days (Better indicated by higher values)</th></tr><tr><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_1 hd_b_ch4.appf.tab2_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_2 hd_b_ch4.appf.tab2_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_3 hd_b_ch4.appf.tab2_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>2</sup></td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_4 hd_b_ch4.appf.tab2_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_5 hd_b_ch4.appf.tab2_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_6 hd_b_ch4.appf.tab2_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>1</sup></td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_7 hd_b_ch4.appf.tab2_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch4.appf.tab2_1_1_1_2 hd_h_ch4.appf.tab2_1_1_2_8 hd_b_ch4.appf.tab2_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">103</td><td headers="hd_h_ch4.appf.tab2_1_1_1_2 hd_h_ch4.appf.tab2_1_1_2_9 hd_b_ch4.appf.tab2_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">103</td><td headers="hd_h_ch4.appf.tab2_1_1_1_3 hd_h_ch4.appf.tab2_1_1_2_10 hd_b_ch4.appf.tab2_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Common OR 1.7 (1.05 to 2.78)<sup>3</sup></td><td headers="hd_h_ch4.appf.tab2_1_1_1_3 hd_h_ch4.appf.tab2_1_1_2_11 hd_b_ch4.appf.tab2_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_ch4.appf.tab2_1_1_1_4 hd_b_ch4.appf.tab2_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>⨁⨁◯◯</p>
|
|
<p>LOW</p>
|
|
</td><td headers="hd_h_ch4.appf.tab2_1_1_1_5 hd_b_ch4.appf.tab2_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_1 hd_h_ch4.appf.tab2_1_1_2_2 hd_h_ch4.appf.tab2_1_1_2_3 hd_h_ch4.appf.tab2_1_1_2_4 hd_h_ch4.appf.tab2_1_1_2_5 hd_h_ch4.appf.tab2_1_1_2_6 hd_h_ch4.appf.tab2_1_1_2_7 hd_h_ch4.appf.tab2_1_1_1_2 hd_h_ch4.appf.tab2_1_1_2_8 hd_h_ch4.appf.tab2_1_1_2_9 hd_h_ch4.appf.tab2_1_1_1_3 hd_h_ch4.appf.tab2_1_1_2_10 hd_h_ch4.appf.tab2_1_1_2_11 hd_h_ch4.appf.tab2_1_1_1_4 hd_h_ch4.appf.tab2_1_1_1_5" id="hd_b_ch4.appf.tab2_1_1_11_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Modified Rankin Scale at 1 year (Better indicated by higher values)</th></tr><tr><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_1 hd_b_ch4.appf.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_2 hd_b_ch4.appf.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_3 hd_b_ch4.appf.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>2</sup></td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_4 hd_b_ch4.appf.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_5 hd_b_ch4.appf.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_6 hd_b_ch4.appf.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>1</sup></td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_7 hd_b_ch4.appf.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch4.appf.tab2_1_1_1_2 hd_h_ch4.appf.tab2_1_1_2_8 hd_b_ch4.appf.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">103</td><td headers="hd_h_ch4.appf.tab2_1_1_1_2 hd_h_ch4.appf.tab2_1_1_2_9 hd_b_ch4.appf.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">103</td><td headers="hd_h_ch4.appf.tab2_1_1_1_3 hd_h_ch4.appf.tab2_1_1_2_10 hd_b_ch4.appf.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Common OR 1.80 (1.09 to 2.99)</td><td headers="hd_h_ch4.appf.tab2_1_1_1_3 hd_h_ch4.appf.tab2_1_1_2_11 hd_b_ch4.appf.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_ch4.appf.tab2_1_1_1_4 hd_b_ch4.appf.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>⨁⨁◯◯</p>
|
|
<p>LOW</p>
|
|
</td><td headers="hd_h_ch4.appf.tab2_1_1_1_5 hd_b_ch4.appf.tab2_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_1 hd_h_ch4.appf.tab2_1_1_2_2 hd_h_ch4.appf.tab2_1_1_2_3 hd_h_ch4.appf.tab2_1_1_2_4 hd_h_ch4.appf.tab2_1_1_2_5 hd_h_ch4.appf.tab2_1_1_2_6 hd_h_ch4.appf.tab2_1_1_2_7 hd_h_ch4.appf.tab2_1_1_1_2 hd_h_ch4.appf.tab2_1_1_2_8 hd_h_ch4.appf.tab2_1_1_2_9 hd_h_ch4.appf.tab2_1_1_1_3 hd_h_ch4.appf.tab2_1_1_2_10 hd_h_ch4.appf.tab2_1_1_2_11 hd_h_ch4.appf.tab2_1_1_1_4 hd_h_ch4.appf.tab2_1_1_1_5" id="hd_b_ch4.appf.tab2_1_1_13_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Symptomatic intracranial haemorrhage at 90 days</th></tr><tr><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_1 hd_b_ch4.appf.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_2 hd_b_ch4.appf.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_3 hd_b_ch4.appf.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious risk of bias</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_4 hd_b_ch4.appf.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_5 hd_b_ch4.appf.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_6 hd_b_ch4.appf.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>1</sup></td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_7 hd_b_ch4.appf.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch4.appf.tab2_1_1_1_2 hd_h_ch4.appf.tab2_1_1_2_8 hd_b_ch4.appf.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>7/103</p>
|
|
<p>(6.8%)</p>
|
|
</td><td headers="hd_h_ch4.appf.tab2_1_1_1_2 hd_h_ch4.appf.tab2_1_1_2_9 hd_b_ch4.appf.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">3.9%</td><td headers="hd_h_ch4.appf.tab2_1_1_1_3 hd_h_ch4.appf.tab2_1_1_2_10 hd_b_ch4.appf.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 1.75 (0.53 to 5.8)</td><td headers="hd_h_ch4.appf.tab2_1_1_1_3 hd_h_ch4.appf.tab2_1_1_2_11 hd_b_ch4.appf.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">29 more per 1000 (from 18 fewer to 187 more)</td><td headers="hd_h_ch4.appf.tab2_1_1_1_4 hd_b_ch4.appf.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>⨁⨁◯◯</p>
|
|
<p>LOW</p>
|
|
</td><td headers="hd_h_ch4.appf.tab2_1_1_1_5 hd_b_ch4.appf.tab2_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IMPORTANT</td></tr><tr><th headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_1 hd_h_ch4.appf.tab2_1_1_2_2 hd_h_ch4.appf.tab2_1_1_2_3 hd_h_ch4.appf.tab2_1_1_2_4 hd_h_ch4.appf.tab2_1_1_2_5 hd_h_ch4.appf.tab2_1_1_2_6 hd_h_ch4.appf.tab2_1_1_2_7 hd_h_ch4.appf.tab2_1_1_1_2 hd_h_ch4.appf.tab2_1_1_2_8 hd_h_ch4.appf.tab2_1_1_2_9 hd_h_ch4.appf.tab2_1_1_1_3 hd_h_ch4.appf.tab2_1_1_2_10 hd_h_ch4.appf.tab2_1_1_2_11 hd_h_ch4.appf.tab2_1_1_1_4 hd_h_ch4.appf.tab2_1_1_1_5" id="hd_b_ch4.appf.tab2_1_1_15_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Recurrent stroke at 90 days</th></tr><tr><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_1 hd_b_ch4.appf.tab2_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_2 hd_b_ch4.appf.tab2_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_3 hd_b_ch4.appf.tab2_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious risk of bias</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_4 hd_b_ch4.appf.tab2_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_5 hd_b_ch4.appf.tab2_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_6 hd_b_ch4.appf.tab2_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>1</sup></td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_7 hd_b_ch4.appf.tab2_1_1_15_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch4.appf.tab2_1_1_1_2 hd_h_ch4.appf.tab2_1_1_2_8 hd_b_ch4.appf.tab2_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>4/103</p>
|
|
<p>(3.9%)</p>
|
|
</td><td headers="hd_h_ch4.appf.tab2_1_1_1_2 hd_h_ch4.appf.tab2_1_1_2_9 hd_b_ch4.appf.tab2_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">2.9%</td><td headers="hd_h_ch4.appf.tab2_1_1_1_3 hd_h_ch4.appf.tab2_1_1_2_10 hd_b_ch4.appf.tab2_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 1.33 (0.31 to 5.81)</td><td headers="hd_h_ch4.appf.tab2_1_1_1_3 hd_h_ch4.appf.tab2_1_1_2_11 hd_b_ch4.appf.tab2_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">10 more per 1000 (from 20 fewer to 139 more)</td><td headers="hd_h_ch4.appf.tab2_1_1_1_4 hd_b_ch4.appf.tab2_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>⨁⨁◯◯</p>
|
|
<p>LOW</p>
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|
</td><td headers="hd_h_ch4.appf.tab2_1_1_1_5 hd_b_ch4.appf.tab2_1_1_15_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IMPORTANT</td></tr><tr><th headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_1 hd_h_ch4.appf.tab2_1_1_2_2 hd_h_ch4.appf.tab2_1_1_2_3 hd_h_ch4.appf.tab2_1_1_2_4 hd_h_ch4.appf.tab2_1_1_2_5 hd_h_ch4.appf.tab2_1_1_2_6 hd_h_ch4.appf.tab2_1_1_2_7 hd_h_ch4.appf.tab2_1_1_1_2 hd_h_ch4.appf.tab2_1_1_2_8 hd_h_ch4.appf.tab2_1_1_2_9 hd_h_ch4.appf.tab2_1_1_1_3 hd_h_ch4.appf.tab2_1_1_2_10 hd_h_ch4.appf.tab2_1_1_2_11 hd_h_ch4.appf.tab2_1_1_1_4 hd_h_ch4.appf.tab2_1_1_1_5" id="hd_b_ch4.appf.tab2_1_1_17_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">EQ-5D at 90 days (Better indicated by higher values)</th></tr><tr><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_1 hd_b_ch4.appf.tab2_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_2 hd_b_ch4.appf.tab2_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_3 hd_b_ch4.appf.tab2_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>2</sup></td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_4 hd_b_ch4.appf.tab2_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_5 hd_b_ch4.appf.tab2_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_6 hd_b_ch4.appf.tab2_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision<sup>4</sup></td><td headers="hd_h_ch4.appf.tab2_1_1_1_1 hd_h_ch4.appf.tab2_1_1_2_7 hd_b_ch4.appf.tab2_1_1_17_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch4.appf.tab2_1_1_1_2 hd_h_ch4.appf.tab2_1_1_2_8 hd_b_ch4.appf.tab2_1_1_17_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">103</td><td headers="hd_h_ch4.appf.tab2_1_1_1_2 hd_h_ch4.appf.tab2_1_1_2_9 hd_b_ch4.appf.tab2_1_1_17_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">103</td><td headers="hd_h_ch4.appf.tab2_1_1_1_3 hd_h_ch4.appf.tab2_1_1_2_10 hd_b_ch4.appf.tab2_1_1_17_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;"></td><td headers="hd_h_ch4.appf.tab2_1_1_1_3 hd_h_ch4.appf.tab2_1_1_2_11 hd_b_ch4.appf.tab2_1_1_17_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">The median EQ-5D at 90 days in the intervention group was 0.33 higher</td><td headers="hd_h_ch4.appf.tab2_1_1_1_4 hd_b_ch4.appf.tab2_1_1_17_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⨁⨁⨁◯</p>
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<p>MODERATE</p>
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</td><td headers="hd_h_ch4.appf.tab2_1_1_1_5 hd_b_ch4.appf.tab2_1_1_17_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IMPORTANT</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="ch4.appf.tab2_1"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed 1 MID or by 2 increments if the confidence interval crossed both MIDs</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="ch4.appf.tab2_2"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="ch4.appf.tab2_3"><p class="no_margin">Adjusted for minimisation factors (NIHSS, therapeutic window, occlusion site and participating centre) and alteplase use.</p></div></dd></dl><dl class="bkr_refwrap"><dt>4</dt><dd><div id="ch4.appf.tab2_4"><p class="no_margin">Imprecision could not be assessed because non-parametric statistics were reported.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch4appftab3"><div id="ch4.appf.tab3" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577865/table/ch4.appf.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch4.appf.tab3_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch4.appf.tab3_1_1_1_1" colspan="7" rowspan="1" style="text-align:center;vertical-align:middle;">Quality assessment</th><th id="hd_h_ch4.appf.tab3_1_1_1_2" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">No of patients</th><th id="hd_h_ch4.appf.tab3_1_1_1_3" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">Effect</th><th id="hd_h_ch4.appf.tab3_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_ch4.appf.tab3_1_1_1_4" style="text-align:center;vertical-align:middle;">Quality</th><th id="hd_h_ch4.appf.tab3_1_1_1_5" rowspan="2" colspan="1" headers="hd_h_ch4.appf.tab3_1_1_1_5" style="text-align:center;vertical-align:middle;">Importance</th></tr><tr><th headers="hd_h_ch4.appf.tab3_1_1_1_1" id="hd_h_ch4.appf.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">No of studies</th><th headers="hd_h_ch4.appf.tab3_1_1_1_1" id="hd_h_ch4.appf.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Design</th><th headers="hd_h_ch4.appf.tab3_1_1_1_1" id="hd_h_ch4.appf.tab3_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk of bias</th><th headers="hd_h_ch4.appf.tab3_1_1_1_1" id="hd_h_ch4.appf.tab3_1_1_2_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Inconsistency</th><th headers="hd_h_ch4.appf.tab3_1_1_1_1" id="hd_h_ch4.appf.tab3_1_1_2_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Indirectness</th><th headers="hd_h_ch4.appf.tab3_1_1_1_1" id="hd_h_ch4.appf.tab3_1_1_2_6" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Imprecision</th><th headers="hd_h_ch4.appf.tab3_1_1_1_1" id="hd_h_ch4.appf.tab3_1_1_2_7" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Other considerations</th><th headers="hd_h_ch4.appf.tab3_1_1_1_2" id="hd_h_ch4.appf.tab3_1_1_2_8" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Thrombectomy plus medical management</th><th headers="hd_h_ch4.appf.tab3_1_1_1_2" id="hd_h_ch4.appf.tab3_1_1_2_9" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Control</th><th headers="hd_h_ch4.appf.tab3_1_1_1_3" id="hd_h_ch4.appf.tab3_1_1_2_10" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Relative (95% CI)</th><th headers="hd_h_ch4.appf.tab3_1_1_1_3" id="hd_h_ch4.appf.tab3_1_1_2_11" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Absolute</th></tr></thead><tbody><tr><th headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_1 hd_h_ch4.appf.tab3_1_1_2_2 hd_h_ch4.appf.tab3_1_1_2_3 hd_h_ch4.appf.tab3_1_1_2_4 hd_h_ch4.appf.tab3_1_1_2_5 hd_h_ch4.appf.tab3_1_1_2_6 hd_h_ch4.appf.tab3_1_1_2_7 hd_h_ch4.appf.tab3_1_1_1_2 hd_h_ch4.appf.tab3_1_1_2_8 hd_h_ch4.appf.tab3_1_1_2_9 hd_h_ch4.appf.tab3_1_1_1_3 hd_h_ch4.appf.tab3_1_1_2_10 hd_h_ch4.appf.tab3_1_1_2_11 hd_h_ch4.appf.tab3_1_1_1_4 hd_h_ch4.appf.tab3_1_1_1_5" id="hd_b_ch4.appf.tab3_1_1_1_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Mortality at 90 days</th></tr><tr><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_1 hd_b_ch4.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_2 hd_b_ch4.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_3 hd_b_ch4.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious risk of bias</td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_4 hd_b_ch4.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_5 hd_b_ch4.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_6 hd_b_ch4.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>1</sup></td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_7 hd_b_ch4.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch4.appf.tab3_1_1_1_2 hd_h_ch4.appf.tab3_1_1_2_8 hd_b_ch4.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>17/164</p>
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<p>(10.4%)</p>
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</td><td headers="hd_h_ch4.appf.tab3_1_1_1_2 hd_h_ch4.appf.tab3_1_1_2_9 hd_b_ch4.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">19.1%</td><td headers="hd_h_ch4.appf.tab3_1_1_1_3 hd_h_ch4.appf.tab3_1_1_2_10 hd_b_ch4.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 0.54 (0.31 to 0.95)</td><td headers="hd_h_ch4.appf.tab3_1_1_1_3 hd_h_ch4.appf.tab3_1_1_2_11 hd_b_ch4.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">88 fewer per 1000 (from 10 fewer to 132 fewer)</td><td headers="hd_h_ch4.appf.tab3_1_1_1_4 hd_b_ch4.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⨁⨁⨁◯</p>
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<p>MODERATE</p>
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</td><td headers="hd_h_ch4.appf.tab3_1_1_1_5 hd_b_ch4.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_1 hd_h_ch4.appf.tab3_1_1_2_2 hd_h_ch4.appf.tab3_1_1_2_3 hd_h_ch4.appf.tab3_1_1_2_4 hd_h_ch4.appf.tab3_1_1_2_5 hd_h_ch4.appf.tab3_1_1_2_6 hd_h_ch4.appf.tab3_1_1_2_7 hd_h_ch4.appf.tab3_1_1_1_2 hd_h_ch4.appf.tab3_1_1_2_8 hd_h_ch4.appf.tab3_1_1_2_9 hd_h_ch4.appf.tab3_1_1_1_3 hd_h_ch4.appf.tab3_1_1_2_10 hd_h_ch4.appf.tab3_1_1_2_11 hd_h_ch4.appf.tab3_1_1_1_4 hd_h_ch4.appf.tab3_1_1_1_5" id="hd_b_ch4.appf.tab3_1_1_3_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Modified Rankin Scale (0 - 2) 90 days</th></tr><tr><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_1 hd_b_ch4.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_2 hd_b_ch4.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_3 hd_b_ch4.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>2</sup></td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_4 hd_b_ch4.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_5 hd_b_ch4.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_6 hd_b_ch4.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision<sup>1</sup></td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_7 hd_b_ch4.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch4.appf.tab3_1_1_1_2 hd_h_ch4.appf.tab3_1_1_2_8 hd_b_ch4.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>87/164</p>
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<p>(53%)</p>
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</td><td headers="hd_h_ch4.appf.tab3_1_1_1_2 hd_h_ch4.appf.tab3_1_1_2_9 hd_b_ch4.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">29.3%</td><td headers="hd_h_ch4.appf.tab3_1_1_1_3 hd_h_ch4.appf.tab3_1_1_2_10 hd_b_ch4.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 1.81 (1.36 to 2.42)</td><td headers="hd_h_ch4.appf.tab3_1_1_1_3 hd_h_ch4.appf.tab3_1_1_2_11 hd_b_ch4.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">237 more per 1000 (from 105 more to 416 more)</td><td headers="hd_h_ch4.appf.tab3_1_1_1_4 hd_b_ch4.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⨁⨁⨁◯</p>
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<p>MODERATE</p>
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</td><td headers="hd_h_ch4.appf.tab3_1_1_1_5 hd_b_ch4.appf.tab3_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_1 hd_h_ch4.appf.tab3_1_1_2_2 hd_h_ch4.appf.tab3_1_1_2_3 hd_h_ch4.appf.tab3_1_1_2_4 hd_h_ch4.appf.tab3_1_1_2_5 hd_h_ch4.appf.tab3_1_1_2_6 hd_h_ch4.appf.tab3_1_1_2_7 hd_h_ch4.appf.tab3_1_1_1_2 hd_h_ch4.appf.tab3_1_1_2_8 hd_h_ch4.appf.tab3_1_1_2_9 hd_h_ch4.appf.tab3_1_1_1_3 hd_h_ch4.appf.tab3_1_1_2_10 hd_h_ch4.appf.tab3_1_1_2_11 hd_h_ch4.appf.tab3_1_1_1_4 hd_h_ch4.appf.tab3_1_1_1_5" id="hd_b_ch4.appf.tab3_1_1_5_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Modified Rankin Scale at 90 days</th></tr><tr><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_1 hd_b_ch4.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_2 hd_b_ch4.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_3 hd_b_ch4.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>2</sup></td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_4 hd_b_ch4.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_5 hd_b_ch4.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_6 hd_b_ch4.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_7 hd_b_ch4.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch4.appf.tab3_1_1_1_2 hd_h_ch4.appf.tab3_1_1_2_8 hd_b_ch4.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">164</td><td headers="hd_h_ch4.appf.tab3_1_1_1_2 hd_h_ch4.appf.tab3_1_1_2_9 hd_b_ch4.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">147</td><td headers="hd_h_ch4.appf.tab3_1_1_1_3 hd_h_ch4.appf.tab3_1_1_2_10 hd_b_ch4.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Common OR 3.1 (2.0 to 4.7)<sup>3</sup></td><td headers="hd_h_ch4.appf.tab3_1_1_1_3 hd_h_ch4.appf.tab3_1_1_2_11 hd_b_ch4.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_ch4.appf.tab3_1_1_1_4 hd_b_ch4.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⨁⨁⨁◯</p>
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<p>MODERATE</p>
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|
</td><td headers="hd_h_ch4.appf.tab3_1_1_1_5 hd_b_ch4.appf.tab3_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_1 hd_h_ch4.appf.tab3_1_1_2_2 hd_h_ch4.appf.tab3_1_1_2_3 hd_h_ch4.appf.tab3_1_1_2_4 hd_h_ch4.appf.tab3_1_1_2_5 hd_h_ch4.appf.tab3_1_1_2_6 hd_h_ch4.appf.tab3_1_1_2_7 hd_h_ch4.appf.tab3_1_1_1_2 hd_h_ch4.appf.tab3_1_1_2_8 hd_h_ch4.appf.tab3_1_1_2_9 hd_h_ch4.appf.tab3_1_1_1_3 hd_h_ch4.appf.tab3_1_1_2_10 hd_h_ch4.appf.tab3_1_1_2_11 hd_h_ch4.appf.tab3_1_1_1_4 hd_h_ch4.appf.tab3_1_1_1_5" id="hd_b_ch4.appf.tab3_1_1_7_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Symptomatic intracranial haemorrhage at 90 days</th></tr><tr><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_1 hd_b_ch4.appf.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_2 hd_b_ch4.appf.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_3 hd_b_ch4.appf.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious risk of bias</td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_4 hd_b_ch4.appf.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_5 hd_b_ch4.appf.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_6 hd_b_ch4.appf.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>1</sup></td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_7 hd_b_ch4.appf.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch4.appf.tab3_1_1_1_2 hd_h_ch4.appf.tab3_1_1_2_8 hd_b_ch4.appf.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>6/165</p>
|
|
<p>(3.6%)</p>
|
|
</td><td headers="hd_h_ch4.appf.tab3_1_1_1_2 hd_h_ch4.appf.tab3_1_1_2_9 hd_b_ch4.appf.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">2.7%</td><td headers="hd_h_ch4.appf.tab3_1_1_1_3 hd_h_ch4.appf.tab3_1_1_2_10 hd_b_ch4.appf.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 1.36 (0.39 to 4.74)</td><td headers="hd_h_ch4.appf.tab3_1_1_1_3 hd_h_ch4.appf.tab3_1_1_2_11 hd_b_ch4.appf.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">10 more per 1000 (from 16 fewer to 101 more)</td><td headers="hd_h_ch4.appf.tab3_1_1_1_4 hd_b_ch4.appf.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
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<p>⨁⨁◯◯</p>
|
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<p>LOW</p>
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</td><td headers="hd_h_ch4.appf.tab3_1_1_1_5 hd_b_ch4.appf.tab3_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IMPORTANT</td></tr><tr><th headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_1 hd_h_ch4.appf.tab3_1_1_2_2 hd_h_ch4.appf.tab3_1_1_2_3 hd_h_ch4.appf.tab3_1_1_2_4 hd_h_ch4.appf.tab3_1_1_2_5 hd_h_ch4.appf.tab3_1_1_2_6 hd_h_ch4.appf.tab3_1_1_2_7 hd_h_ch4.appf.tab3_1_1_1_2 hd_h_ch4.appf.tab3_1_1_2_8 hd_h_ch4.appf.tab3_1_1_2_9 hd_h_ch4.appf.tab3_1_1_1_3 hd_h_ch4.appf.tab3_1_1_2_10 hd_h_ch4.appf.tab3_1_1_2_11 hd_h_ch4.appf.tab3_1_1_1_4 hd_h_ch4.appf.tab3_1_1_1_5" id="hd_b_ch4.appf.tab3_1_1_9_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Malignant middle cerebral syndrome at 90 days</th></tr><tr><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_1 hd_b_ch4.appf.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_2 hd_b_ch4.appf.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_3 hd_b_ch4.appf.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious risk of bias</td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_4 hd_b_ch4.appf.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_5 hd_b_ch4.appf.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_6 hd_b_ch4.appf.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_7 hd_b_ch4.appf.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch4.appf.tab3_1_1_1_2 hd_h_ch4.appf.tab3_1_1_2_8 hd_b_ch4.appf.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>8/165</p>
|
|
<p>(4.8%)</p>
|
|
</td><td headers="hd_h_ch4.appf.tab3_1_1_1_2 hd_h_ch4.appf.tab3_1_1_2_9 hd_b_ch4.appf.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">18.7%</td><td headers="hd_h_ch4.appf.tab3_1_1_1_3 hd_h_ch4.appf.tab3_1_1_2_10 hd_b_ch4.appf.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 0.26 (0.12 to 0.55)</td><td headers="hd_h_ch4.appf.tab3_1_1_1_3 hd_h_ch4.appf.tab3_1_1_2_11 hd_b_ch4.appf.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">138 fewer per 1000 (from 84 fewer to 165 fewer)</td><td headers="hd_h_ch4.appf.tab3_1_1_1_4 hd_b_ch4.appf.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">⨁⨁⨁⨁ HIGH</td><td headers="hd_h_ch4.appf.tab3_1_1_1_5 hd_b_ch4.appf.tab3_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IMPORTANT</td></tr><tr><th headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_1 hd_h_ch4.appf.tab3_1_1_2_2 hd_h_ch4.appf.tab3_1_1_2_3 hd_h_ch4.appf.tab3_1_1_2_4 hd_h_ch4.appf.tab3_1_1_2_5 hd_h_ch4.appf.tab3_1_1_2_6 hd_h_ch4.appf.tab3_1_1_2_7 hd_h_ch4.appf.tab3_1_1_1_2 hd_h_ch4.appf.tab3_1_1_2_8 hd_h_ch4.appf.tab3_1_1_2_9 hd_h_ch4.appf.tab3_1_1_1_3 hd_h_ch4.appf.tab3_1_1_2_10 hd_h_ch4.appf.tab3_1_1_2_11 hd_h_ch4.appf.tab3_1_1_1_4 hd_h_ch4.appf.tab3_1_1_1_5" id="hd_b_ch4.appf.tab3_1_1_11_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">EQ-5D VAS at 90 days (Better indicated by higher values)</th></tr><tr><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_1 hd_b_ch4.appf.tab3_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_2 hd_b_ch4.appf.tab3_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_3 hd_b_ch4.appf.tab3_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>2</sup></td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_4 hd_b_ch4.appf.tab3_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_5 hd_b_ch4.appf.tab3_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_6 hd_b_ch4.appf.tab3_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision<sup>4</sup></td><td headers="hd_h_ch4.appf.tab3_1_1_1_1 hd_h_ch4.appf.tab3_1_1_2_7 hd_b_ch4.appf.tab3_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch4.appf.tab3_1_1_1_2 hd_h_ch4.appf.tab3_1_1_2_8 hd_b_ch4.appf.tab3_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">164</td><td headers="hd_h_ch4.appf.tab3_1_1_1_2 hd_h_ch4.appf.tab3_1_1_2_9 hd_b_ch4.appf.tab3_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">147</td><td headers="hd_h_ch4.appf.tab3_1_1_1_3 hd_h_ch4.appf.tab3_1_1_2_10 hd_b_ch4.appf.tab3_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;"></td><td headers="hd_h_ch4.appf.tab3_1_1_1_3 hd_h_ch4.appf.tab3_1_1_2_11 hd_b_ch4.appf.tab3_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">The median EQ-5D at 90 days in the intervention group was 15 higher</td><td headers="hd_h_ch4.appf.tab3_1_1_1_4 hd_b_ch4.appf.tab3_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>⨁⨁⨁◯</p>
|
|
<p>MODERATE</p>
|
|
</td><td headers="hd_h_ch4.appf.tab3_1_1_1_5 hd_b_ch4.appf.tab3_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IMPORTANT</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="ch4.appf.tab3_1"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed 1 MID or by 2 increments if the confidence interval crossed both MIDs</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="ch4.appf.tab3_2"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="ch4.appf.tab3_3"><p class="no_margin">Adjusted for age, sex, baseline NIHSS, baseline ASPECTS, occlusion location and alteplase use.</p></div></dd></dl><dl class="bkr_refwrap"><dt>4</dt><dd><div id="ch4.appf.tab3_4"><p class="no_margin">Imprecision could not be assessed because non-parametric statistics were reported.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobch4appftab4"><div id="ch4.appf.tab4" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577865/table/ch4.appf.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch4.appf.tab4_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_ch4.appf.tab4_1_1_1_1" colspan="7" rowspan="1" style="text-align:center;vertical-align:middle;">Quality assessment</th><th id="hd_h_ch4.appf.tab4_1_1_1_2" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">No of patients</th><th id="hd_h_ch4.appf.tab4_1_1_1_3" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">Effect</th><th id="hd_h_ch4.appf.tab4_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_ch4.appf.tab4_1_1_1_4" style="text-align:center;vertical-align:middle;">Quality</th><th id="hd_h_ch4.appf.tab4_1_1_1_5" rowspan="2" colspan="1" headers="hd_h_ch4.appf.tab4_1_1_1_5" style="text-align:center;vertical-align:middle;">Importance</th></tr><tr><th headers="hd_h_ch4.appf.tab4_1_1_1_1" id="hd_h_ch4.appf.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">No of studies</th><th headers="hd_h_ch4.appf.tab4_1_1_1_1" id="hd_h_ch4.appf.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Design</th><th headers="hd_h_ch4.appf.tab4_1_1_1_1" id="hd_h_ch4.appf.tab4_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk of bias</th><th headers="hd_h_ch4.appf.tab4_1_1_1_1" id="hd_h_ch4.appf.tab4_1_1_2_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Inconsistency</th><th headers="hd_h_ch4.appf.tab4_1_1_1_1" id="hd_h_ch4.appf.tab4_1_1_2_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Indirectness</th><th headers="hd_h_ch4.appf.tab4_1_1_1_1" id="hd_h_ch4.appf.tab4_1_1_2_6" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Imprecision</th><th headers="hd_h_ch4.appf.tab4_1_1_1_1" id="hd_h_ch4.appf.tab4_1_1_2_7" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Other considerations</th><th headers="hd_h_ch4.appf.tab4_1_1_1_2" id="hd_h_ch4.appf.tab4_1_1_2_8" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Thrombectomy plus medical management</th><th headers="hd_h_ch4.appf.tab4_1_1_1_2" id="hd_h_ch4.appf.tab4_1_1_2_9" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Control</th><th headers="hd_h_ch4.appf.tab4_1_1_1_3" id="hd_h_ch4.appf.tab4_1_1_2_10" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Relative (95% CI)</th><th headers="hd_h_ch4.appf.tab4_1_1_1_3" id="hd_h_ch4.appf.tab4_1_1_2_11" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Absolute</th></tr></thead><tbody><tr><th headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_1 hd_h_ch4.appf.tab4_1_1_2_2 hd_h_ch4.appf.tab4_1_1_2_3 hd_h_ch4.appf.tab4_1_1_2_4 hd_h_ch4.appf.tab4_1_1_2_5 hd_h_ch4.appf.tab4_1_1_2_6 hd_h_ch4.appf.tab4_1_1_2_7 hd_h_ch4.appf.tab4_1_1_1_2 hd_h_ch4.appf.tab4_1_1_2_8 hd_h_ch4.appf.tab4_1_1_2_9 hd_h_ch4.appf.tab4_1_1_1_3 hd_h_ch4.appf.tab4_1_1_2_10 hd_h_ch4.appf.tab4_1_1_2_11 hd_h_ch4.appf.tab4_1_1_1_4 hd_h_ch4.appf.tab4_1_1_1_5" id="hd_b_ch4.appf.tab4_1_1_1_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Mortality at 90 days</th></tr><tr><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_1 hd_b_ch4.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_2 hd_b_ch4.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_3 hd_b_ch4.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious risk of bias</td><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_4 hd_b_ch4.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>1</sup></td><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_5 hd_b_ch4.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_6 hd_b_ch4.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>2</sup></td><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_7 hd_b_ch4.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch4.appf.tab4_1_1_1_2 hd_h_ch4.appf.tab4_1_1_2_8 hd_b_ch4.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>33/199</p>
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<p>(16.6%)</p>
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</td><td headers="hd_h_ch4.appf.tab4_1_1_1_2 hd_h_ch4.appf.tab4_1_1_2_9 hd_b_ch4.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">21.9%</td><td headers="hd_h_ch4.appf.tab4_1_1_1_3 hd_h_ch4.appf.tab4_1_1_2_10 hd_b_ch4.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 0.76 (0.41 to 1.40)</td><td headers="hd_h_ch4.appf.tab4_1_1_1_3 hd_h_ch4.appf.tab4_1_1_2_11 hd_b_ch4.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">53 fewer per 1000 (from 129 fewer to 88 more)</td><td headers="hd_h_ch4.appf.tab4_1_1_1_4 hd_b_ch4.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⨁◯◯◯</p>
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<p>VERY LOW</p>
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</td><td headers="hd_h_ch4.appf.tab4_1_1_1_5 hd_b_ch4.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_1 hd_h_ch4.appf.tab4_1_1_2_2 hd_h_ch4.appf.tab4_1_1_2_3 hd_h_ch4.appf.tab4_1_1_2_4 hd_h_ch4.appf.tab4_1_1_2_5 hd_h_ch4.appf.tab4_1_1_2_6 hd_h_ch4.appf.tab4_1_1_2_7 hd_h_ch4.appf.tab4_1_1_1_2 hd_h_ch4.appf.tab4_1_1_2_8 hd_h_ch4.appf.tab4_1_1_2_9 hd_h_ch4.appf.tab4_1_1_1_3 hd_h_ch4.appf.tab4_1_1_2_10 hd_h_ch4.appf.tab4_1_1_2_11 hd_h_ch4.appf.tab4_1_1_1_4 hd_h_ch4.appf.tab4_1_1_1_5" id="hd_b_ch4.appf.tab4_1_1_3_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Modified Rankin Scale (0 - 2) 90 days</th></tr><tr><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_1 hd_b_ch4.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_2 hd_b_ch4.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_3 hd_b_ch4.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>3</sup></td><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_4 hd_b_ch4.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_5 hd_b_ch4.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_6 hd_b_ch4.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_7 hd_b_ch4.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch4.appf.tab4_1_1_1_2 hd_h_ch4.appf.tab4_1_1_2_8 hd_b_ch4.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>93/199</p>
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<p>(46.7%)</p>
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</td><td headers="hd_h_ch4.appf.tab4_1_1_1_2 hd_h_ch4.appf.tab4_1_1_2_9 hd_b_ch4.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">14.9%</td><td headers="hd_h_ch4.appf.tab4_1_1_1_3 hd_h_ch4.appf.tab4_1_1_2_10 hd_b_ch4.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 3.16 (2.17 to 4.59)</td><td headers="hd_h_ch4.appf.tab4_1_1_1_3 hd_h_ch4.appf.tab4_1_1_2_11 hd_b_ch4.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">322 more per 1000 (from 174 more to 535 more)</td><td headers="hd_h_ch4.appf.tab4_1_1_1_4 hd_b_ch4.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⨁⨁⨁◯</p>
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<p>MODERATE</p>
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</td><td headers="hd_h_ch4.appf.tab4_1_1_1_5 hd_b_ch4.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_1 hd_h_ch4.appf.tab4_1_1_2_2 hd_h_ch4.appf.tab4_1_1_2_3 hd_h_ch4.appf.tab4_1_1_2_4 hd_h_ch4.appf.tab4_1_1_2_5 hd_h_ch4.appf.tab4_1_1_2_6 hd_h_ch4.appf.tab4_1_1_2_7 hd_h_ch4.appf.tab4_1_1_1_2 hd_h_ch4.appf.tab4_1_1_2_8 hd_h_ch4.appf.tab4_1_1_2_9 hd_h_ch4.appf.tab4_1_1_1_3 hd_h_ch4.appf.tab4_1_1_2_10 hd_h_ch4.appf.tab4_1_1_2_11 hd_h_ch4.appf.tab4_1_1_1_4 hd_h_ch4.appf.tab4_1_1_1_5" id="hd_b_ch4.appf.tab4_1_1_5_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Modified Rankin Scale at 90 days</th></tr><tr><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_1 hd_b_ch4.appf.tab4_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_2 hd_b_ch4.appf.tab4_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_3 hd_b_ch4.appf.tab4_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>3</sup></td><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_4 hd_b_ch4.appf.tab4_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_5 hd_b_ch4.appf.tab4_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_6 hd_b_ch4.appf.tab4_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_7 hd_b_ch4.appf.tab4_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch4.appf.tab4_1_1_1_2 hd_h_ch4.appf.tab4_1_1_2_8 hd_b_ch4.appf.tab4_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">92</td><td headers="hd_h_ch4.appf.tab4_1_1_1_2 hd_h_ch4.appf.tab4_1_1_2_9 hd_b_ch4.appf.tab4_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">90</td><td headers="hd_h_ch4.appf.tab4_1_1_1_3 hd_h_ch4.appf.tab4_1_1_2_10 hd_b_ch4.appf.tab4_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Common OR 3.36 (1.96 to 5.77)<sup>4</sup></td><td headers="hd_h_ch4.appf.tab4_1_1_1_3 hd_h_ch4.appf.tab4_1_1_2_11 hd_b_ch4.appf.tab4_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_ch4.appf.tab4_1_1_1_4 hd_b_ch4.appf.tab4_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⨁⨁⨁◯</p>
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<p>MODERATE</p>
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</td><td headers="hd_h_ch4.appf.tab4_1_1_1_5 hd_b_ch4.appf.tab4_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_1 hd_h_ch4.appf.tab4_1_1_2_2 hd_h_ch4.appf.tab4_1_1_2_3 hd_h_ch4.appf.tab4_1_1_2_4 hd_h_ch4.appf.tab4_1_1_2_5 hd_h_ch4.appf.tab4_1_1_2_6 hd_h_ch4.appf.tab4_1_1_2_7 hd_h_ch4.appf.tab4_1_1_1_2 hd_h_ch4.appf.tab4_1_1_2_8 hd_h_ch4.appf.tab4_1_1_2_9 hd_h_ch4.appf.tab4_1_1_1_3 hd_h_ch4.appf.tab4_1_1_2_10 hd_h_ch4.appf.tab4_1_1_2_11 hd_h_ch4.appf.tab4_1_1_1_4 hd_h_ch4.appf.tab4_1_1_1_5" id="hd_b_ch4.appf.tab4_1_1_7_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Symptomatic intracranial haemorrhage at 90 days</th></tr><tr><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_1 hd_b_ch4.appf.tab4_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_2 hd_b_ch4.appf.tab4_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_3 hd_b_ch4.appf.tab4_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious risk of bias</td><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_4 hd_b_ch4.appf.tab4_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_5 hd_b_ch4.appf.tab4_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_6 hd_b_ch4.appf.tab4_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>2</sup></td><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_7 hd_b_ch4.appf.tab4_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch4.appf.tab4_1_1_1_2 hd_h_ch4.appf.tab4_1_1_2_8 hd_b_ch4.appf.tab4_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>12/199</p>
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<p>(6%)</p>
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</td><td headers="hd_h_ch4.appf.tab4_1_1_1_2 hd_h_ch4.appf.tab4_1_1_2_9 hd_b_ch4.appf.tab4_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">3.7%</td><td headers="hd_h_ch4.appf.tab4_1_1_1_3 hd_h_ch4.appf.tab4_1_1_2_10 hd_b_ch4.appf.tab4_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 1.63 (0.66 to 4.06)</td><td headers="hd_h_ch4.appf.tab4_1_1_1_3 hd_h_ch4.appf.tab4_1_1_2_11 hd_b_ch4.appf.tab4_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">23 more per 1000 (from 13 fewer to 113 more)</td><td headers="hd_h_ch4.appf.tab4_1_1_1_4 hd_b_ch4.appf.tab4_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>⨁⨁◯◯</p>
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<p>LOW</p>
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</td><td headers="hd_h_ch4.appf.tab4_1_1_1_5 hd_b_ch4.appf.tab4_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IMPORTANT</td></tr><tr><th headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_1 hd_h_ch4.appf.tab4_1_1_2_2 hd_h_ch4.appf.tab4_1_1_2_3 hd_h_ch4.appf.tab4_1_1_2_4 hd_h_ch4.appf.tab4_1_1_2_5 hd_h_ch4.appf.tab4_1_1_2_6 hd_h_ch4.appf.tab4_1_1_2_7 hd_h_ch4.appf.tab4_1_1_1_2 hd_h_ch4.appf.tab4_1_1_2_8 hd_h_ch4.appf.tab4_1_1_2_9 hd_h_ch4.appf.tab4_1_1_1_3 hd_h_ch4.appf.tab4_1_1_2_10 hd_h_ch4.appf.tab4_1_1_2_11 hd_h_ch4.appf.tab4_1_1_1_4 hd_h_ch4.appf.tab4_1_1_1_5" id="hd_b_ch4.appf.tab4_1_1_9_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Procedural complications</th></tr><tr><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_1 hd_b_ch4.appf.tab4_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_2 hd_b_ch4.appf.tab4_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomised trials</td><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_3 hd_b_ch4.appf.tab4_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious risk of bias</td><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_4 hd_b_ch4.appf.tab4_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_5 hd_b_ch4.appf.tab4_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_6 hd_b_ch4.appf.tab4_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_ch4.appf.tab4_1_1_1_1 hd_h_ch4.appf.tab4_1_1_2_7 hd_b_ch4.appf.tab4_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_ch4.appf.tab4_1_1_1_2 hd_h_ch4.appf.tab4_1_1_2_8 hd_b_ch4.appf.tab4_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
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<p>7/107</p>
|
|
<p>(6.5%)</p>
|
|
</td><td headers="hd_h_ch4.appf.tab4_1_1_1_2 hd_h_ch4.appf.tab4_1_1_2_9 hd_b_ch4.appf.tab4_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">0%</td><td headers="hd_h_ch4.appf.tab4_1_1_1_3 hd_h_ch4.appf.tab4_1_1_2_10 hd_b_ch4.appf.tab4_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Peto OR 7.27 (1.61 to 32.73)</td><td headers="hd_h_ch4.appf.tab4_1_1_1_3 hd_h_ch4.appf.tab4_1_1_2_11 hd_b_ch4.appf.tab4_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_ch4.appf.tab4_1_1_1_4 hd_b_ch4.appf.tab4_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
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<p>⨁⨁⨁⨁</p>
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<p>HIGH</p>
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|
</td><td headers="hd_h_ch4.appf.tab4_1_1_1_5 hd_b_ch4.appf.tab4_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">IMPORTANT</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="ch4.appf.tab4_1"><p class="no_margin">Downgraded by 1 increment for unexplained heterogeneity with I2 >50%</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="ch4.appf.tab4_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed 1 MID or by 2 increments if the confidence interval crossed both MIDs</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="ch4.appf.tab4_3"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>4</dt><dd><div id="ch4.appf.tab4_4"><p class="no_margin">Odds ratio adjusted for stratification factors (age, core infarct volume, time from symptom onset to enrolment, baseline NIHSS, and trial site.</p></div></dd></dl></dl></div></div></div></article><article data-type="fig" id="figobch4appgfig1"><div id="ch4.appg.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%2018.%20Flow%20chart%20of%20health%20economic%20study%20selection%20for%20the%20guideline.&p=BOOKS&id=577865_ch4appgf1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK577865/bin/ch4appgf1.jpg" alt="Figure 18. Flow chart of health economic study selection for the guideline." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 18</span><span class="title">Flow chart of health economic study selection for the guideline</span></h3><div class="caption"><p>* Non-relevant population, intervention, comparison, design or setting; non-English language</p></div></div></article><article data-type="table-wrap" id="figobch4apphtab1"><div id="ch4.apph.tab1" class="table"><h3><span class="label">Table 14</span><span class="title">Studies excluded from the clinical review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577865/table/ch4.apph.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch4.apph.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Exclusion reason</th></tr></thead><tbody><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Abou-Chebl 2015<a class="bibr" href="#ch4.ref1" rid="ch4.ref1"><sup>1</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect population: not proven large vessel occlusion on non-invasive angiography</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Akins 2014<a class="bibr" href="#ch4.ref3" rid="ch4.ref3"><sup>3</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Published prior to 2015</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Al-Ajlan 2016<a class="bibr" href="#ch4.ref4" rid="ch4.ref4"><sup>4</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design: secondary analysis with no relevant outcomes</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Albers 2015<a class="bibr" href="#ch4.ref5" rid="ch4.ref5"><sup>5</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design: secondary analysis with no relevant outcomes</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ali Raza 2017<a class="bibr" href="#ch4.ref8" rid="ch4.ref8"><sup>8</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect interventions</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Andersson 2013<a class="bibr" href="#ch4.ref9" rid="ch4.ref9"><sup>9</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison: all had mechanical thrombectomy</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Assis 2018<a class="bibr" href="#ch4.ref12" rid="ch4.ref12"><sup>12</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design: secondary analysis with no relevant outcomes</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Baek 2014<a class="bibr" href="#ch4.ref13" rid="ch4.ref13"><sup>13</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison: all had mechanical thrombectomy.</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Becktepe 2011<a class="bibr" href="#ch4.ref14" rid="ch4.ref14"><sup>14</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Published prior to 2015</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Broderick 2015<a class="bibr" href="#ch4.ref18" rid="ch4.ref18"><sup>18</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pooled analysis: individual studies included</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Broussalis 2013<a class="bibr" href="#ch4.ref19" rid="ch4.ref19"><sup>19</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design: observational and no adjustment for confounders</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Campbell 2016<a class="bibr" href="#ch4.ref20" rid="ch4.ref20"><sup>20</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IPD analysis - individual studies included</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ciccone 2013<a class="bibr" href="#ch4.ref24" rid="ch4.ref24"><sup>24</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Published prior to 2015</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Costalat 2011<a class="bibr" href="#ch4.ref26" rid="ch4.ref26"><sup>26</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison: all had combination treatment in the posterior circulatory stroke subgroup</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Costalat 2012<a class="bibr" href="#ch4.ref25" rid="ch4.ref25"><sup>25</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison: all basilar stroke patients received combination treatment</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Coutinho 2017<a class="bibr" href="#ch4.ref27" rid="ch4.ref27"><sup>27</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design: posthoc analysis of pre-2015 trials</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dias 2017<a class="bibr" href="#ch4.ref31" rid="ch4.ref31"><sup>31</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect population: not proven large vessel occlusion on non-invasive angiography</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diener 2015<a class="bibr" href="#ch4.ref32" rid="ch4.ref32"><sup>32</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not English language (German)</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dorn 2012<a class="bibr" href="#ch4.ref34" rid="ch4.ref34"><sup>34</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison: all had mechanical thrombectomy</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dornak 2015<a class="bibr" href="#ch4.ref35" rid="ch4.ref35"><sup>35</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect interventions</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ecker-Schlipf 2009<a class="bibr" href="#ch4.ref36" rid="ch4.ref36"><sup>36</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not in English language</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ganesh 2016<a class="bibr" href="#ch4.ref39" rid="ch4.ref39"><sup>39</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design: post hoc analysis of predictors for infarct in a new territory</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gerber 2017<a class="bibr" href="#ch4.ref40" rid="ch4.ref40"><sup>40</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison: stent versus aspiration thrombectomy</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gory 2016<a class="bibr" href="#ch4.ref41" rid="ch4.ref41"><sup>41</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison: all had mechanical thrombectomy.</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Goyal 2016<a class="bibr" href="#ch4.ref43" rid="ch4.ref43"><sup>43</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review: quality assessment is inadequate and methods are not adequate/unclear</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Haussen 2018<a class="bibr" href="#ch4.ref44" rid="ch4.ref44"><sup>44</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect population: observational study of a mixed stroke population with no separate analysis for the posterior circulatory stroke</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">He 2017<a class="bibr" href="#ch4.ref45" rid="ch4.ref45"><sup>45</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design: non-comparative study</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Health Quality Ontario 2016<a class="bibr" href="#ch4.ref46" rid="ch4.ref46"><sup>46</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review: methods are not adequate/unclear</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Heshmatollah 2017<a class="bibr" href="#ch4.ref47" rid="ch4.ref47"><sup>47</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect population: subgroup analysis of people with atrial fibrillation</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hong 2016<a class="bibr" href="#ch4.ref48" rid="ch4.ref48"><sup>48</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Khatri 2013<a class="bibr" href="#ch4.ref52" rid="ch4.ref52"><sup>52</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Published prior to 2015</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Khoury 2017<a class="bibr" href="#ch4.ref53" rid="ch4.ref53"><sup>53</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect population: not proven large vessel occlusion on non-invasive angiography</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kidwell 2013<a class="bibr" href="#ch4.ref55" rid="ch4.ref55"><sup>55</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Published prior to 2015</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kidwell 2014<a class="bibr" href="#ch4.ref54" rid="ch4.ref54"><sup>54</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Published prior to 2015</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kim 2015<a class="bibr" href="#ch4.ref56" rid="ch4.ref56"><sup>56</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect population: observational study of a mixed stroke population with no separate analysis for the posterior circulatory strokes</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kocher 2014<a class="bibr" href="#ch4.ref57" rid="ch4.ref57"><sup>57</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not in English language</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kumar 2015<a class="bibr" href="#ch4.ref58" rid="ch4.ref58"><sup>58</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review: study designs inappropriate and incorrect interventions</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lefevre 2014<a class="bibr" href="#ch4.ref59" rid="ch4.ref59"><sup>59</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect interventions: all had mechanical thrombectomy</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Maier 2017<a class="bibr" href="#ch4.ref62" rid="ch4.ref62"><sup>62</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect population: observational study of a mixed stroke population with no separate analysis for the posterior circulatory stroke</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mazighi 2009<a class="bibr" href="#ch4.ref63" rid="ch4.ref63"><sup>63</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect population: observational study of a mixed stroke population with no separate analysis for the posterior circulatory stroke</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Menjot de Champfleur 2017<a class="bibr" href="#ch4.ref64" rid="ch4.ref64"><sup>64</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect comparison: imaging techniques</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mistry 2017<a class="bibr" href="#ch4.ref65" rid="ch4.ref65"><sup>65</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review: methods are not adequate/unclear and quality assessment is inadequate</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mordasini 2013<a class="bibr" href="#ch4.ref68" rid="ch4.ref68"><sup>68</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison: all had mechanical thrombectomy</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mortimer 2012<a class="bibr" href="#ch4.ref69" rid="ch4.ref69"><sup>69</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review published prior to 2015.</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mourand 2014<a class="bibr" href="#ch4.ref70" rid="ch4.ref70"><sup>70</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison: all had mechanical thrombectomy</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mulder 2016<a class="bibr" href="#ch4.ref72" rid="ch4.ref72"><sup>72</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect comparison</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Nagel 2013<a class="bibr" href="#ch4.ref73" rid="ch4.ref73"><sup>73</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect interventions: only 20/36 in EVT arm had EVT</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Nogueira 2012<a class="bibr" href="#ch4.ref77" rid="ch4.ref77"><sup>77</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Published prior to 2015</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Nogueira 2012<a class="bibr" href="#ch4.ref78" rid="ch4.ref78"><sup>78</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Published prior to 2015</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">O’rourke 2010<a class="bibr" href="#ch4.ref79" rid="ch4.ref79"><sup>79</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Published prior to 2015</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ottomeyer 2012<a class="bibr" href="#ch4.ref80" rid="ch4.ref80"><sup>80</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect comparison in multivariable analysis</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Palesch 2015<a class="bibr" href="#ch4.ref81" rid="ch4.ref81"><sup>81</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect population: not proven large vessel occlusion on non-invasive angiography</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Park 2013<a class="bibr" href="#ch4.ref82" rid="ch4.ref82"><sup>82</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison: all had mechanical thrombectomy</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Phan 2016<a class="bibr" href="#ch4.ref83" rid="ch4.ref83"><sup>83</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review: majority of studies included are pre-2015.</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Raychev 2015<a class="bibr" href="#ch4.ref85" rid="ch4.ref85"><sup>85</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Roth 2011<a class="bibr" href="#ch4.ref86" rid="ch4.ref86"><sup>86</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison: all had mechanical thrombectomy</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rouchaud 2011<a class="bibr" href="#ch4.ref87" rid="ch4.ref87"><sup>87</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review: methods are not adequate/unclear and quality assessment is inadequate</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Saver 2012<a class="bibr" href="#ch4.ref94" rid="ch4.ref94"><sup>94</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect interventions. Published prior to 2015</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Saver 2014<a class="bibr" href="#ch4.ref93" rid="ch4.ref93"><sup>93</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Published prior to 2015</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Saver 2016<a class="bibr" href="#ch4.ref92" rid="ch4.ref92"><sup>92</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">IPD meta-analysis - individual studies included</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Schonewille 2007<a class="bibr" href="#ch4.ref95" rid="ch4.ref95"><sup>95</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Published prior to 2015</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Schonewille 2009<a class="bibr" href="#ch4.ref96" rid="ch4.ref96"><sup>96</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect outcome (1 month follow-up)</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sherman 2000<a class="bibr" href="#ch4.ref97" rid="ch4.ref97"><sup>97</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Published prior to 2015</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sheth 2015<a class="bibr" href="#ch4.ref98" rid="ch4.ref98"><sup>98</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sheth 2016<a class="bibr" href="#ch4.ref99" rid="ch4.ref99"><sup>99</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect interventions</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Shi 2010<a class="bibr" href="#ch4.ref100" rid="ch4.ref100"><sup>100</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Published prior to 2015</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Singer 2013<a class="bibr" href="#ch4.ref102" rid="ch4.ref102"><sup>102</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison: all had mechanical thrombectomy</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Singer 2015<a class="bibr" href="#ch4.ref101" rid="ch4.ref101"><sup>101</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison: all had mechanical thrombectomy</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Smith 2015<a class="bibr" href="#ch4.ref103" rid="ch4.ref103"><sup>103</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review: quality assessment is inadequate and methods are not adequate/unclear.</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tian 2017<a class="bibr" href="#ch4.ref105" rid="ch4.ref105"><sup>105</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect population: observational study of a mixed stroke population with no separate analysis for the posterior circulatory stroke</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Touma 2016<a class="bibr" href="#ch4.ref106" rid="ch4.ref106"><sup>106</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review: quality assessment is inadequate and methods are not adequate/unclear</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Von Kummer 2005<a class="bibr" href="#ch4.ref108" rid="ch4.ref108"><sup>108</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect interventions</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Webb 2012<a class="bibr" href="#ch4.ref109" rid="ch4.ref109"><sup>109</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inadequate adjustment for confounders</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wen 2017<a class="bibr" href="#ch4.ref110" rid="ch4.ref110"><sup>110</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design: no comparator.</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Wyszomirski 2017<a class="bibr" href="#ch4.ref111" rid="ch4.ref111"><sup>111</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review: study designs inappropriate.</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Xianxian 2017<a class="bibr" href="#ch4.ref112" rid="ch4.ref112"><sup>112</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Observational study with no adjustment for confounders and unclear reporting</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yang 2017<a class="bibr" href="#ch4.ref114" rid="ch4.ref114"><sup>114</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect interventions</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yang 2017<a class="bibr" href="#ch4.ref115" rid="ch4.ref115"><sup>115</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect interventions and outcomes.</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yoshimura 2011<a class="bibr" href="#ch4.ref116" rid="ch4.ref116"><sup>116</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Observational study with no adjustment for confounders</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Yoshimura 2014<a class="bibr" href="#ch4.ref117" rid="ch4.ref117"><sup>117</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect population: observational study of a mixed stroke population with no separate analysis for the posterior circulatory stroke</td></tr><tr><td headers="hd_h_ch4.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Zaidat 2018<a class="bibr" href="#ch4.ref118" rid="ch4.ref118"><sup>118</sup></a></td><td headers="hd_h_ch4.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect study design</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobch4apphtab2"><div id="ch4.apph.tab2" class="table"><h3><span class="label">Table 15</span><span class="title">Studies excluded from the health economic review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK577865/table/ch4.apph.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch4.apph.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_ch4.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference</th><th id="hd_h_ch4.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reason for exclusion</th></tr></thead><tbody><tr><td headers="hd_h_ch4.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Achit 2017<a class="bibr" href="#ch4.ref2" rid="ch4.ref2"><sup>2</sup></a></td><td headers="hd_h_ch4.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">This study was assessed as partially applicable with minor limitations. However, the other available evidence was judged to be of greater applicability, and therefore this study was selectively excluded.</td></tr><tr><td headers="hd_h_ch4.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Aronsson 2016<a class="bibr" href="#ch4.ref10" rid="ch4.ref10"><sup>10</sup></a></td><td headers="hd_h_ch4.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">This study was assessed as partially applicable with minor limitations. However, the other available evidence was judged to be of greater applicability, and therefore this study was selectively excluded.</td></tr><tr><td headers="hd_h_ch4.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Arora 2018<a class="bibr" href="#ch4.ref11" rid="ch4.ref11"><sup>11</sup></a></td><td headers="hd_h_ch4.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">This study was assessed as partially applicable with potentially serious limitations. However, the other available evidence was judged to be of greater applicability and methodological quality, and therefore this study was selectively excluded.</td></tr><tr><td headers="hd_h_ch4.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bouvy 2013<a class="bibr" href="#ch4.ref16" rid="ch4.ref16"><sup>16</sup></a></td><td headers="hd_h_ch4.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">This study was assessed as partially applicable with potentially serious limitations. However, the other available evidence was judged to be of greater applicability and methodological quality, and therefore this study was selectively excluded.</td></tr><tr><td headers="hd_h_ch4.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Campbell 2017<a class="bibr" href="#ch4.ref22" rid="ch4.ref22"><sup>22</sup></a></td><td headers="hd_h_ch4.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">This study was assessed as partially applicable with potentially serious limitations. However, the other available evidence was judged to be of greater applicability and methodological quality, and therefore this study was selectively excluded.</td></tr><tr><td headers="hd_h_ch4.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">De Andres-Nogales 2017<a class="bibr" href="#ch4.ref29" rid="ch4.ref29"><sup>29</sup></a></td><td headers="hd_h_ch4.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">This study was assessed as partially applicable with potentially serious limitations. However, the other available evidence was judged to be of greater applicability and methodological quality, and therefore this study was selectively excluded.</td></tr><tr><td headers="hd_h_ch4.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Health Quality Ontario 2016<a class="bibr" href="#ch4.ref46" rid="ch4.ref46"><sup>46</sup></a></td><td headers="hd_h_ch4.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">This study was assessed as partially applicable with minor limitations. However, the other available evidence was judged to be of greater applicability, and therefore this study was selectively excluded.</td></tr><tr><td headers="hd_h_ch4.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Jeong 2017<a class="bibr" href="#ch4.ref50" rid="ch4.ref50"><sup>50</sup></a></td><td headers="hd_h_ch4.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">This study was assessed as partially applicable with potentially serious limitations. However, the other available evidence was judged to be of greater applicability and methodological quality, and therefore this study was selectively excluded.</td></tr><tr><td headers="hd_h_ch4.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ruggeri 2018<a class="bibr" href="#ch4.ref88" rid="ch4.ref88"><sup>88</sup></a></td><td headers="hd_h_ch4.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">This study was assessed as partially applicable with minor limitations. However, the other available evidence was judged to be of greater applicability, and therefore this study was selectively excluded.</td></tr><tr><td headers="hd_h_ch4.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Steen Carlsson 2017<a class="bibr" href="#ch4.ref104" rid="ch4.ref104"><sup>104</sup></a></td><td headers="hd_h_ch4.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">This study was assessed as partially applicable with minor limitations. However, the other available evidence was judged to be of greater applicability, and therefore this study was selectively excluded.</td></tr><tr><td headers="hd_h_ch4.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Trippoli 2018<a class="bibr" href="#ch4.ref107" rid="ch4.ref107"><sup>107</sup></a></td><td headers="hd_h_ch4.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">This study was assessed as partially applicable with minor limitations. However, the other available evidence was judged to be of greater applicability, and therefore this study was selectively excluded.</td></tr><tr><td headers="hd_h_ch4.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Xie 2016<a class="bibr" href="#ch4.ref113" rid="ch4.ref113"><sup>113</sup></a></td><td headers="hd_h_ch4.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">This study was assessed as partially applicable with minor limitations. However, the other available evidence was judged to be of greater applicability, and therefore this study was selectively excluded.</td></tr></tbody></table></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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