Amal Albaqami
Pre-Med A2
Ms. Ruth
ENGL 211
Critique
October 25, 2020
Bilgic, A. B., Gocmen, R., Arsava, E. M., & Topcuoglu, M. A. (2020). The Effect of Clot Volume and Permeability on Response to Intravenous Tissue Plasminogen Activator in Acute Ischemic Stroke. Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association, 29(2), 104541. Retrieved from https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104541
The response to Intravenous Tissue Plasminogen Activator (IV tPA) is highly determined by the size, content, and location in the clot, causing Acute Ischemic Stroke. In the article, The Effect of Clot Volume and Permeability on Response to Intravenous Tissue Plasminogen Activator in Acute Ischemic Stroke Bilgic et al. (2020) determined the interaction between IV tPA and clot perviousness and the relationship between clot heterogeneity and tPA responsiveness. Although this research had more practical methods and findings as compared to the previous studies, it was limited by visual co-registration of plain CT and CTA and a small number of participants employed.
The authors used the National Institute of Health Stroke Scale (NIHSS) to quantify the severity of acute stroke among patients. Besides, Modified Rankin’s score was used to evaluate the performance of this experiment at the end of 3 months. Although other researchers had conducted similar studies before, Bilgic et al.’s were more advanced and accurate. For instance, all participants underwent non-contrast CT and CTA before stroke thrombosis was conducted. According to Pavabvash et al. (2017)” the location of thrombus within the segment of the middle cerebral artery (MCA) can predict angiographic and clinical outcomes in stroke patients.”1 As such, this study introduced a new concept of clot homogeneity. It examined the ability of middle cerebral artery clot distance from the ICA terminus, which lacked in the previous similar studies. Therefore, this study was accurate and reliable.
This study employed consecutive acute stroke patients with CTA proximal segment middle cerebral artery occlusion, who were undergoing intravenous tPA treatment for eight years. Although the authors argue that patients with significant vessel occlusion are referred to as interventional treatment instead of systematic thrombolytic therapy, the study population was small to be generalized to the whole population. Tipton E (2014) argues that small samples are considered non-representative of the population and its findings not generalizable.2 For instance, Bilgic et al. (2020) employed only 84 acute stroke patients during their research. Besides, all patients were aged between 54 years and 82 years. As such, no considerations were taken into account about patients who did not belong to the age bracket. Therefore, the generalizability of this study was a question since the sample population was relatively small.
The authors employed new methods and techniques during their experiment, but only a few participants were employed in this study. Previous findings from other studies did not reveal the aspect of clot homogeneity as such Bilgic et al. (2020) measured clot attenuation and its standard deviation as a determinant of clot homogeneity. This study used unique measurement tools and hence provided accurate and realistic findings. However, the study population was relatively small and only consisted of acute stroke patients who were around 68 years of age. Further clinical and technical studies on this subject are needed to reconcile the effectiveness of the outcomes with the various limitations experienced in this study.
References
- Pavabvash S, Taleb S, Majidi S, Qureshi AI. Correlation of acute M1 middle cerebral artery thrombus location with endovascular treatment success and clinical outcome. Journal of Vascular and Interventional Neurology. 2017 Jan;9(3):17. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5317287/
- Tipton E. How generalizable is your experiment? An index for comparing experimental samples and populations. Journal of Educational and Behavioral Statistics. 2014 Dec;39(6):478-501. ):17. Available at: https://www.semanticscholar.org/paper/How-Generalizable-Is-Your-Experiment-An-Index-for-Tipton/a32f61439fc21b7fb428185d0f7fbe91d2e2ebf3