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Correspondence |

Percutaneous Clot Removal in Acute Ischemic Stroke

Pitchaiah Mandava, MD, PhD; Thomas A. Kent, MD
Arch Neurol. 2009;66(2):283-284. doi:10.1001/archneurol.2008.549.
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We have many concerns regarding the article titled “Percutaneous Clot Removal Devices in Acute Ischemic Stroke: A Systematic Review and Meta-analysis” by Stead et al.1 While we appreciate the need for an article reviewing the efficacy of thrombectomy devices, this particular review has serious methodological problems that put its conclusions of improved outcome with thrombectomy in doubt.

Stead and colleagues included both single case reports and series with small numbers. Studies with small numbers are most prone to publication bias.2 Methods such as the funnel plot are recommended to detect bias,2 but with small series where all subjects have the same outcome, the odds ratio would be an implausible 0 or infinity, making the funnel plot meaningless and casting doubt on the basis for the study's conclusions.

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