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Common Data Elements Analysis of Mechanical Thrombectomy Clinical Trials for Acute Ischemic Stroke with Large Core Infarct

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Abstract

Background

Clinical trials addressing large core acute ischemic stroke (AIS) are ongoing across multiple international groups. Future development of clinical guidelines depends on meta-analyses of these trials calling for a degree of homogeneity of elements across the studies. This common data element study aims to provide an overview of key features of pertinent large core infarct trials.

Methods

PubMed and ClinicalTrials.gov databases were screened for published and ongoing clinical trials assessing mechanical thrombectomy in patients with AIS with large core infarct. Nested Knowledge AutoLit living review platform was utilized to categorize primary and secondary outcomes as well as inclusion and exclusion criteria for patient selection in the trials.

Results

The most reported data element was ASPECTS score but with varied definitions of what constitutes large core. Non-utility-weighted modified Rankin score (mRS) was reported in 6/7 studies as the primary outcome, while the utility-weighted mRS was the outcome of interest in the TESLA trial, all of them at the 3 months mark, with only LASTE looking for mRS shift at the 6 months mark. Secondary outcomes had more variations. Mortality is reported separately only in 4/7 trials, all at the 3‑month mark. Additionally, the TENSION trial reported the frequency of serious adverse events, including mortality, at the 1‑week and 12-month mark.

Discussion

Overall, in large core trials there is a large degree of heterogeneity in the collected data elements. Differences in definition and timepoints render reaching a unified standard difficult, which hinders high quality meta-analyses and cohesive evidence-driven synthesis.

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Funding

This study has not received any specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Mohamed Sobhi Jabal, Mohamed K. Ibrahim, Sherief Ghozy, Cem Bilgin, Waleed Brinjikji & David F. Kallmes

  2. Department of Computer and Information Science, University of Pennsylvania, Philadelphia, PA, USA

    Mohamed Sobhi Jabal

  3. Nested Knowledge Inc, Saint Paul, MN, USA

    Jade Thurnham, Kevin M. Kallmes, Nicole Hardy & Ranita Tarchand

  4. Central Michigan University College of Medicine, Mt. Pleasant, MI, USA

    Hassan Kobeissi

  5. Neuroadiology and Neurointervention Division, Stanford University, Palo Alto, CA, USA

    Jeremy J. Heit

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  1. Mohamed Sobhi Jabal
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Correspondence to Mohamed Sobhi Jabal.

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Conflict of interest

J. Thurnham and R. Tarchand work for Nested Knowledge Inc. K.M. Kallmes works for and holds equity in Nested Knowledge Inc, works for Conway Medical LLC, and holds equity in Superior MedicalExperts Inc. N. Hardy works for and holds equity in Nested Knowledge Inc. J.J. Heit is a consultant for Medtronic and MicroVention and is a member of the scientific and medical advisory board for iSchemaView. D.F. Kallmes has ownership in Nested Knowledge Inc, Superior Medical Experts Inc, and Conway Medical LLC; research support from Microvention, Balt USA, and Medtronic. M.S. Jabal, M.K. Ibrahim, H. Kobeissi, S. Ghozy, C. Bilgin and W. Brinjikji declare that they have no competing interests.

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Jabal, M.S., Ibrahim, M.K., Thurnham, J. et al. Common Data Elements Analysis of Mechanical Thrombectomy Clinical Trials for Acute Ischemic Stroke with Large Core Infarct. Clin Neuroradiol 33, 307–317 (2023). https://doi.org/10.1007/s00062-022-01239-x

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