2018 AANS Annual Scientific Meeting-Prospective Clinical Trials in Neurovascular Surgery: The Good, The Bad & The Ugly

Video Transcription

Video Summary

Dr. Kevin Cockcroft gives a lecture on prospective clinical trials in neurovascular surgery, focusing on the good, the bad, and the ugly examples. He starts by emphasizing the importance of evidence-based medicine in neurosurgery and the need to assess the quality of evidence in clinical trials. He discusses the four levels of evidence used to classify clinical research studies and explains the characteristics of each level. Level 1 evidence is considered the gold standard and involves high-quality randomized controlled trials. Level 2 evidence includes moderate or poor quality randomized controlled trials and good quality cohort studies. Level 3 evidence consists of moderate or poor quality cohort studies, while level 4 evidence includes case series and case reports. Dr. Cockcroft also highlights the importance of linking evidence to the strength of recommendations in evidence-based medicine guidelines. He then presents examples of good, bad, and ugly trials in neurovascular surgery. The good example is the Mr. Clean trial, a high-quality randomized controlled trial that showed favorable outcomes for acute ischemic stroke patients treated with mechanical intervention. The bad example is the ARUBA trial, which had significant limitations in design and yielded conflicting results on the treatment of unruptured arteriovenous malformations. The ugly example is the CREST-2 trial, which is complex and challenging due to variations in patient inclusion criteria and potential selection bias. Dr. Cockcroft concludes by suggesting that prospective registries can be a viable alternative to prospective randomized controlled trials for certain clinical questions in neurovascular surgery.

Asset Caption

Kevin M. Cockroft, MD, FAANS

Keywords

prospective clinical trials

neurovascular surgery

evidence-based medicine

levels of evidence

randomized controlled trials

strength of recommendations