The 2018 ter Brugge Lecture: Problems with the Introduction of Innovations in Neurovascular Care

The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques
Jean RaymondTim E Darsaut

Abstract

Most endovascular innovations have been introduced into clinical care by showing good outcomes in small enthusiastic case series of selected patients. Randomized clinical trials (RCTs) have rarely been performed, except for acute ischemic stroke, but even then most trial designs were too explanatory to inform clinical decisions. In this article, we review 2 × 2 tables and forest plots that summarize RCT results to examine methodological issues in the design and interpretation of clinical studies. Research results can apply in practice when RCTs are all-inclusive, pragmatic trials. Common problems include the following: (i) using restrictive eligibility criteria in explanatory trials, instead of including the diversity of patients in need of care, which hampers future generalizability of results; (ii) ignoring an entire line of the 2 × 2 table and excluding patients who do not meet the proposed criteria of a diagnostic test in its evaluation (perfusion studies) which renders clinical inferences misleading; (iii) ignoring an entire column of the 2 × 2 table and comparing different patients treated using the same treatment instead of different treatments in the same patients (the "wrong axis" comparisons of prognostic studies and ...Continue Reading

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Citations

Mar 30, 2020·Neuroradiology·Tim E DarsautJean Raymond
Sep 16, 2020·Journal of Neurointerventional Surgery·René ChapotJean Raymond
Nov 7, 2019·Interventional Neuroradiology : Journal of Peritherapeutic Neuroradiology, Surgical Procedures and Related Neurosciences·Jean RaymondTim E Darsaut
Oct 31, 2020·Trials·Tim E Darsaut, Jean Raymond
Oct 15, 2019·Journal of Neuroradiology. Journal De Neuroradiologie·Grégoire Boulouis, Robert Fahed

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