Kaimen Rigor reviewed

Rigor-Reviewed Manuscript

Intra-arterial tenecteplase after successful endovascular recanalisation in patients with acute posterior circulation arterial occlusion (ATTENTION-IA): multicentre randomised controlled trial.

Name: Kaimen Rigor review — Intra-arterial tenecteplase after successful endovascular recanalisation in patients with acute posterior circulation arterial occlusion (ATTENTION-IA): multicentre randomised controlled trial.
Item: Intra-arterial tenecteplase after successful endovascular recanalisation in patients with acute posterior circulation arterial occlusion (ATTENTION-IA): multicentre randomised controlled trial.
Rating: 59
Author: Alpha1

Hu W, Tao C, Wang L, Chen Z, Li D, Chen W, Yi T, Xu L, Yu C, Wang T, Yao X, Cui T, Yuan G, Su J, Chen L, Zhou Z, Ma Z, Wang J, Wang B, Han H, Wang H, Chen J, Zhou P, Cao Z, Ren Y, Cai X, Shi H, Zhang G, Yu L, Yuan X, Li J, Zeng G, Ni C, Li T, Wu Y, Li Y, Li K, Liu Y, Wang Y, Jin Y, Liu H, Wen J, Sun J, Zhu Y, Li R, Zhang C, Liu T, Song J, Wang L, Cheng J, Qureshi AI, Nguyen TN, Saver JL, Nogueira RG, Liu X

Paper source

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Kaimen Rigor review — 2.5★ (Weak), 0 critical, 3 high issues for “Intra-arterial tenecteplase after successful endovascular recanalisation in patients with acute posterior circulation arterial occlusion (ATTENTION-IA): multicentre randomised controlled trial.”

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Alpha1 Editorial

This rigor review was examined and confirmed by Alpha1 Editorial · August 15, 2026

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Intra-arterial tenecteplase after successful endovascular recanalisation in patients with acute posterior circulation arterial occlusion (ATTENTION-IA): multicentre randomised controlled trial.

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DOI

10.1136/bmj-2024-080489

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Issued Aug 15, 2026Engine 7.39.0

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Kaimen Rigor reviewed

Rigor-Reviewed Manuscript

Intra-arterial tenecteplase after successful endovascular recanalisation in patients with acute posterior circulation arterial occlusion (ATTENTION-IA): multicentre randomised controlled trial.

Paper source

Intra-arterial tenecteplase after successful endovascular recanalisation in patients with acute posterior circulation arterial occlusion (ATTENTION-IA): multicentre randomised controlled trial.

Read full text (PMC)

Embed this Rigor badge

Links back to this Kaimen Rigor review.

Alpha1 Editorial

This rigor review was examined and confirmed by Alpha1 Editorial · August 15, 2026

Kaimen Rigor review

Kaimen Rigor reviewed

2.5 / 5

Weak — serious problems found

Interventional Study

Critical

High-priority

How this rating was calculated▸

Started at 5★ — deductions

IntegrityIntegrity concern ×2−1★
StatisticsStatistic did not reproduce−0.5★
ClaimsTreatment effect not shown to be clinically meaningful−0.5★
StatisticsPrinted percentage does not match its own count (capped) ×4−0.25★
ReportingData & code availability partially met−0.25★

Model-reported confidence: highReviewer agreement: highEngine: 7.39.0Source: full text

Not verified in this report

The numeric-impossibility checks (GRIM/GRIMMER/DEBIT/SPRITE) did not run: 8 reported means were read, and their group size is not stated where the values are printed (this source has no machine-readable table structure). These checks need the count the mean was averaged over, so none was performed.
No data or code availability links were detected to verify.

Biggest issues

01Printed percentage does not match its own count
highArithmeticrecomputedFull detail
8.3% does not match the reported count 8/104
“eight patients (8.3%) in the tenecteplase group”
ResultsFind in source
02Treatment effect not shown to be clinically meaningful
highOverreachreviewer-assessedFull detail
The primary outcome showed no statistically significant difference (adjusted risk ratio 1.36, 95% CI 0.92 to 2.02; P=0.12). The absolute difference was 8.3 percentage points, but the confidence interval includes zero and the study was powered to detect an 18% absolute risk reduction. The effect is not statistically supported and lacks clinical meaningfulness.
“adjusted risk ratio 1.36, 95% confidence interval 0.92 to 2.02; P=0.12; adjusted absolute difference 8.3 percentage points, 95% CI −3.8 to 20.4”
Find in source
03Printed percentage does not match its own count
mediumArithmeticrecomputedFull detail
3.1% does not match the reported count 3/104
“three (3.1%) in the control group”
ResultsFind in source
04Printed percentage does not match its own count
mediumArithmeticrecomputedFull detail
69% does not match the reported count 144/208
“basilar artery in 144 (69%) patients”
ResultsFind in source
05Printed percentage does not match its own count
mediumArithmeticrecomputedFull detail
5% does not match the reported count 10/208
“posterior cerebral artery in 10 (5%)”
ResultsFind in source
06Printed percentage does not match its own count
mediumArithmeticrecomputedFull detail
69% does not match the reported count 72/104
“Large artery atherosclerosis | 72 (69.0)”
Table 1Find in source

Findings by category

301ArithmeticNumerical inconsistencies 102OverreachOverstated conclusions 03AuthenticityNone found 104DisclosureReporting gaps 05AvailabilityNone found · partly checked 106CopyeditCopyediting

This Kaimen Rigor review uses Kaimen Rigor reviewers trained on a curated corpus of high-fidelity and retracted papers, with expert supervision and curation. It can still make mistakes; verify each finding against the source before relying on it.

This is a well-conducted randomised controlled trial with rigorous design, clear reporting of methods and results, and appropriate statistical analysis. The main weaknesses are a vague data availability statement and minor reporting gaps (outlier handling, reporting guideline adherence).

Both reviewers classified the study as interventional (RCT), and no divergence was present. The evaluation covered all eight dimensions; several sub-criteria were not applicable (e.g., animal-related, cell line, controls). The statistics verification component could only recompute a subset of tests; the absence of detected errors does not confirm overall statistical correctness.

Numerical inconsistencies

3 findings · worst high

Values that contradict each other or are impossible for the stated sample: recomputed p-values and test statistics, GRIM/GRIMMER checks on summary numbers, percentages against their own counts, totals against their parts, and estimates against their own confidence intervals.

Summary statistic impossible for the stated N (GRIM/GRIMMER)Recomputed
Printed percentage does not match its own countRecomputed
Internal contradictions in the reported numbersAssessed

Recomputed 2 tests: 2 consistent, 0 inconsistent; 1 recomputed directly from the reported test statistics, 1 via agent-written checks. 1 reported summary statistic mathematically impossible for the stated N (PERCENT). 4 printed percentages that do not match their own count.

Overstated conclusions

1 finding · worst high

Conclusions that reach past what the paper's own results support — including a significance claim that no longer holds when the statistic is recomputed, and efficacy resting on an unvalidated surrogate endpoint.

Treatment effect not shown to be clinically meaningfulAssessed

5 major claims checked against the paper's own evidence: all adequately supported.

Premise concern: effect size not shown to be clinically meaningful.

Data authenticity concerns

None found

An adversarial read for patterns associated with data that may not be genuine: results that look too clean, implausibly large effects, duplicated data or images, and methods that do not match the results reported.

Checked — nothing surfaced.

Reporting gaps

1 finding · worst medium

Required detail the manuscript never states — study design, biological variables, ethics approval and consent, key resources, statistical reporting, data and code availability, and overall transparency.

Data/code availability incompleteAssessed

Eight Dimensions7 pass · 1 warn

The introduction cites the CHOICE trial and ATTENTION trial to establish the rationale for adjunctive intra-arterial thrombolysis. The hypothesis follows logically from the cited evidence. Limitations of prior work (e.g., anterior circulation focus) are acknowledged, and the study addresses the gap for posterior circulation.

Sub-criteria

prior work citedADEQUATE

premise rationaleADEQUATE

limitations addressedADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

The premise is well-established with prior trials (CHOICE, ATTENTION) cited and a clear rationale for the study.

Evidence

“Adjunctive intra-arterial infusion of thrombolytic agents appeared promising for large vessel occlusions of the anterior circulation in the phase 2b chemical optimization of cerebral embolectomy (CHOICE) randomised trial (121 participants).”

Introduction ¶3Find in source

“Adjunctive intra-arterial infusion of thrombolytic agents after successful endovascular recanalisation has the potential to further improve outcomes by lysing persisting thrombi in distal arteries and the microcirculation.”

Introduction ¶2Find in source

“However, it remains uncertain whether this treatment approach could benefit patients with acute occlusions of the posterior circulation.”

Introduction ¶3Find in source

PASSReviewer 2· 90% conf

The paper establishes a clear scientific premise, citing prior work (CHOICE trial) and providing a logical rationale for the study.

Evidence

Introduction ¶3Find in source

Introduction ¶2Find in source

absence[Introduction]

Limitations of prior research are not explicitly discussed.

Randomisation was central, web-based, computer-generated, with a 1:1 ratio. Blinding of outcome assessors and imaging committee is described. Sample size calculation is provided with assumptions and power. Inclusion/exclusion criteria are detailed. The analysis population (ITT) and per-protocol are defined. Outlier handling is not explicitly discussed, but missing data handling is described (no imputation needed).

Sub-criteria

controlsN/A

power analysisADEQUATE

blinding levelsADEQUATE

outlier handlingINADEQUATE

randomization unitADEQUATE

inclusion exclusionADEQUATE

randomization methodADEQUATE

replicate distinctionN/A

independent replicationN/A

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 95% conf

The trial design is rigorous: randomised, open-label with blinded endpoint adjudication, pre-specified sample size, and clear inclusion/exclusion criteria.

Evidence

“A simple randomisation process was conducted through a web based system (IRLite), accessible on mobile devices or web page platforms, utilising a central, web based, computer generated randomisation schedule.”

MethodsFind in source

“all research staff conducting telephone interviews and members of the independent endpoint adjudication committee were, however, masked to the treatment assignment.”

MethodsFind in source

“Based on a two sided, normal approximation test, α of 0.05, and a 1:1 randomisation, 99 patients in the treatment group and 99 in the control group would provide 80% power for comparison of the proportion of patients who achieved the primary endpoint.”

MethodsFind in source

PASSReviewer 2· 90% conf

The trial design is rigorous: randomised, with a clear randomization method, blinding of outcome assessors, a priori sample size calculation, and pre-specified inclusion/exclusion criteria.

Evidence

MethodsFind in source

“all research staff conducting telephone interviews and members of the independent endpoint adjudication committee were, however, masked to the treatment assignment.”

MethodsFind in source

The paper reports age, sex, and various comorbidities in Table 1. Age and sex are reported for the whole cohort and per group. Health status is captured via NIHSS and pc-ASPECTS. Demographics are adequate for a human trial.

Sub-criteria

demographicsADEQUATE

sex reportedADEQUATE

sex justifiedN/A

age weight healthADEQUATE

housing conditionsN/A

species strain sourceN/A

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

Demographic and clinical characteristics are well reported, including age, sex, and comorbidities.

Evidence

“The mean age was 66.0 (standard deviation 11.1) years, and 24.5% (n=51) were women.”

ResultsFind in source

“Mean (SD) age (years) | 65.0 (11.3) | 67.3 (10.8) | 0.17”

Table 1Find in source

PASSReviewer 2· 90% conf

Demographic and clinical characteristics are well reported, including age, sex, and key comorbidities.

Evidence

“The mean age was 66.0 (standard deviation 11.1) years, and 24.5% (n=51) were women.”

ResultsFind in source

“Mean (SD) age (years) | 65.0 (11.3) | 67.3 (10.8)”

Table 1Find in source

The paper states approval by the medical ethics committee of the First Affiliated Hospital of the University of Science and Technology of China and all relevant local ethics committees. Informed consent is mentioned in the randomisation section. Compliance with Good Clinical Practice and Declaration of Helsinki is stated.

Sub-criteria

iacuc statementN/A

informed consentADEQUATE

irb ethics statementADEQUATE

regulatory complianceADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 95% conf

Ethical approval from a named committee and informed consent are documented.

Evidence

“Approved by the medical ethics committee of the First Affiliated Hospital of the University of Science and Technology of China and all relevant local ethics committees.”

EthicsFind in source

“Once written informed consent had been obtained and successful endovascular recanalisation (extended thrombolysis in cerebral infarction (eTICI) grade 2b50-3 defined as ≥50% reperfusion of the involved territory) of the target occlusion performed, patients were randomised”

MethodsFind in source

“The trial was conducted in accordance to Good Clinical Practice and the Declaration of Helsinki.”

EthicsFind in source

PASSReviewer 2· 90% conf

Ethical approval and informed consent are adequately reported.

Evidence

“Approved by the medical ethics committee of the First Affiliated Hospital of the University of Science and Technology of China and all relevant local ethics committees.”

EthicsFind in source

paraphrase[Methods, Randomisation and masking]

“Once written informed consent had been obtained and successful endovascular recanalisation ... performed, patients were randomised”

“The trial was conducted in accordance to Good Clinical Practice and the Declaration of Helsinki.”

EthicsFind in source

Tenecteplase is named with dose (0.0625 mg/kg, max 6.25 mg) and route. The supplier is mentioned in acknowledgments. Statistical software (STATA 17.0) is identified. No other key biological/chemical resources are used.

Sub-criteria

mycoplasma testingN/A

reagents identifiedADEQUATE

organisms identifiedN/A

antibodies identifiedN/A

cell line authenticationN/A

software tools identifiedADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

The investigational product (tenecteplase) is identified with dose and regimen; statistical software is identified.

Evidence

“Patients randomised to the tenecteplase group received an intra-arterial infusion of tenecteplase (0.0625 mg/kg, maximum dose 6.25 mg) through a distal access catheter or microcatheter located proximal to the residual thrombus (if still present) or distal to the origin of the main pontine perforator branches over 15 seconds.”

MethodsFind in source

“All analyses were performed using STATA software, version 17.0.”

Statistical analysisFind in source

PASSReviewer 2· 90% conf

The investigational product (tenecteplase) is adequately identified, and statistical software is named.

Evidence

“Patients randomised to the tenecteplase group received an intra-arterial infusion of tenecteplase (0.0625 mg/kg, maximum dose 6.25 mg) through a distal access catheter or microcatheter”

MethodsFind in source

“All analyses were performed using STATA software, version 17.0.”

Statistical analysisFind in source

Tests are named (Poisson regression with robust variance, ordinal logistic regression, linear regression). Assumptions are addressed (proportional odds verified with Brant test). Exact p-values are reported for primary outcome. Effect sizes with CIs are reported throughout. Software is identified. Data presentation includes per-group n and CIs. Mathematical plausibility checks: no obvious errors; subgroup counts sum correctly.

Sub-criteria

tests namedADEQUATE

exact p valuesADEQUATE

effect sizes ciADEQUATE

data presentationADEQUATE

software identifiedADEQUATE

assumptions verifiedADEQUATE

mathematical plausibilityPASS

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

Statistical methods are appropriate and well-described; effect sizes with confidence intervals are reported; no arithmetic errors detected.

Evidence

“A robust sandwich variance model was used to compare dichotomous outcomes: relative risk was estimated using the Poisson distribution with a log link function.”

Statistical analysisFind in source

“adjusted risk ratio 1.36, 95% confidence interval (CI) 0.92 to 2.02; P=0.12”

ResultsFind in source

“mRS score 0 or 1 at day 90† | 36 (34.6) | 27 (26.0) | RR | 1.33 (0.88 to 2.03) | 1.36 (0.92 to 2.02)”

Table 2Find in source

PASSReviewer 2· 90% conf

Statistical methods are appropriate and well described, with effect sizes and confidence intervals reported; p-values are exact where reported.

Evidence

“A robust sandwich variance model was used to compare dichotomous outcomes: relative risk was estimated using the Poisson distribution with a log link function.”

Statistical analysisFind in source

“adjusted risk ratio 1.36, 95% confidence interval (CI) 0.92 to 2.02; P=0.12”

ResultsFind in source

“mRS score 0 or 1 at day 90† | 36 (34.6) | 27 (26.0) | RR | 1.33 (0.88 to 2.03) | 1.36 (0.92 to 2.02)”

Table 2Find in source

The data availability statement says data can be made available on reasonable request after signing data sharing agreements, but does not specify a platform, conditions, or timeframe. This is reported_but_inadequate. No code sharing is mentioned, but no bespoke code is described.

Sub-criteria

code sharingN/A

accession numbersN/A

repository depositN/A

data availability statementINADEQUATE

Per reviewer (2) — the votes behind the verdict

WARNReviewer 1· 90% conf

A data availability statement exists but is vague ('on reasonable request' with no clear mechanism or timeframe).

Evidence

“Data collected for the study, including deidentified individual participant data and a data dictionary defining each field in the set, can be made available to researchers on reasonable request and after signing appropriate data sharing agreements.”

Data availabilityFind in source

WARNReviewer 2· 90% conf

A data availability statement exists but is vague, lacking a concrete access mechanism or timeframe.

Evidence

Data availabilityFind in source

Trial registration number is provided. Methods are comprehensive. Limitations are explicitly discussed. Conclusions are proportional to the results. Funding and competing interests are declared. No reporting guideline checklist is mentioned, but the paper follows CONSORT-like structure.

Sub-criteria

funding coiADEQUATE

trial registrationADEQUATE

reporting guidelineNOT REPORTED

methods completenessADEQUATE

all outcomes reportedADEQUATE

limitations discussedADEQUATE

conclusions proportionalADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 95% conf

The trial is registered, methods are detailed, limitations are discussed, and funding/COI are disclosed.

Evidence

“Trial registration ClinicalTrials.gov NCT05684172 (https://clinicaltrials.gov/ct2/show/NCT05684172) .”

AbstractFind in source

“This study had several limitations. Firstly, as only patients from China were enrolled into the study, our results may not be generalisable to patients in western countries.”

LimitationsFind in source

“Funding: This study was funded by the Fundamental Research Funds for the Central Universities (YD9110002014).”

FundingFind in source

PASSReviewer 2· 90% conf

The manuscript is transparent: registered, reports all outcomes, discusses limitations, and provides funding/COI statements.

Evidence

“Trial registration ClinicalTrials.gov NCT05684172 (https://clinicaltrials.gov/ct2/show/NCT05684172)”

AbstractFind in source

“This study had several limitations. Firstly, as only patients from China were enrolled into the study, our results may not be generalisable to patients in western countries.”

LimitationsFind in source

“Funding: This study was funded by the Fundamental Research Funds for the Central Universities (YD9110002014).”

FundingFind in source

Registered (1 ID: ClinicalTrials.gov). No reporting guideline cited.

Broken references and links

None found · partly checked

References checked against Crossref, OpenAlex and Retraction Watch for retractions and resolvability, plus declared data and code links probed for whether they resolve to content matching the paper.

Nothing surfaced — but not everything feeding this category ran (missing: data/code link verification), so read this as a partial clean bill.

Checked 29 references by DOI: 28 verified — 1 no DOI (shown, not verified).

Copyediting

1 finding · worst low

Wording, consistency and formatting errors that need correcting before submission.

Wording or formatting errors that need correctingAssessed

6 copyedit issues flagged (1 major): mostly consistency, typo, grammar.

Kaimen Rigor Action ItemsFinal pass before journal submission

The published work is methodologically robust and transparent, with only minor reporting gaps. An informed reader should weigh the vague data availability statement and the minor internal inconsistencies (per-protocol percentage, absolute difference) as points that could warrant clarification or an erratum, but they do not undermine the main conclusions.

1.
HIGHreporting
Correct the per-protocol analysis percentage in Methods, Trial design: 206 out of 208 is 99%, not 81%. Verify the correct number or percentage.
This internal inconsistency is a factual error that could undermine reader trust and may warrant an erratum.
2.
HIGHreporting
Clarify the comparison in the Discussion statement about mRS 0-1 proportions (ATTENTION vs ATTENTION-IA): specify which group and time point are being compared.
The ambiguous comparison could mislead readers about the treatment effect.
3.
HIGHdata code
Improve the Data availability statement to specify a concrete access mechanism (e.g., a named repository or data access committee) and conditions/timeframe for data sharing.
The current 'on reasonable request' statement is vague and does not meet transparency standards for a data-driven trial.
4.
MEDIUMreporting
Explicitly state adherence to CONSORT reporting guidelines in the Methods or a separate section.
Explicit guideline adherence improves transparency and is expected for RCTs.
5.
MEDIUMrigor
Clarify outlier handling in the statistical analysis section, or state that no outliers were excluded.
The current reporting is ambiguous and could be misinterpreted.
6.
MEDIUMdata code
Add a statement about the availability of statistical analysis code, even if not shared, to clarify reproducibility.
Code availability is increasingly expected and clarifies reproducibility.
7.
MEDIUMstatistics
Report exact p-values for secondary outcomes where only CIs are given, to aid interpretation.
Exact p-values allow readers to assess statistical significance more precisely.
8.
LOWcopyedit
Fix the stray semicolon in the Abstract Results: change '36.4%; P=0.047' to '36.4%, P=0.047'.
Minor typographical error that should be corrected for clarity.
9.
LOWcopyedit
Capitalize 'All' at the start of the sentence in Methods, Randomisation and masking.
Sentence begins with lowercase 'all', which is a grammatical error.
10.
LOWreporting
Reconcile the reported adjusted absolute difference in the primary outcome: Results state 8.3 percentage points, Discussion states 7.6%. Clarify the discrepancy.
Minor internal inconsistency that could confuse readers.

Full text (49,779 chars)Analyzed: Aug 15, 2026

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Intra-arterial tenecteplase after successful endovascular recanalisation in patients with acute posterior circulation arterial occlusion (ATTENTION-IA): multicentre randomised controlled trial.

Read full text (PMC)

DOI

10.1136/bmj-2024-080489

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Record fingerprint

f675573c4bacc4b74f5b45dc8d3ab3a483e2be6ceac3f34f69e0926c854a74e4

Verify via API

Issued Aug 15, 2026Engine 7.39.0

Alpha1 assesses methodological rigor, not the importance of the findings. See how we calibrate →

Kaimen Rigor review

Kaimen Rigor reviewed

2.5 / 5

Weak — serious problems found

Interventional Study

Critical

High-priority

How this rating was calculated▸

Started at 5★ — deductions

IntegrityIntegrity concern ×2−1★
StatisticsStatistic did not reproduce−0.5★
ClaimsTreatment effect not shown to be clinically meaningful−0.5★
StatisticsPrinted percentage does not match its own count (capped) ×4−0.25★
ReportingData & code availability partially met−0.25★

Model-reported confidence: highReviewer agreement: highEngine: 7.39.0Source: full text

Not verified in this report

The numeric-impossibility checks (GRIM/GRIMMER/DEBIT/SPRITE) did not run: 8 reported means were read, and their group size is not stated where the values are printed (this source has no machine-readable table structure). These checks need the count the mean was averaged over, so none was performed.
No data or code availability links were detected to verify.

Biggest issues

01Printed percentage does not match its own count
highArithmeticrecomputedFull detail
8.3% does not match the reported count 8/104
“eight patients (8.3%) in the tenecteplase group”
ResultsFind in source
02Treatment effect not shown to be clinically meaningful
highOverreachreviewer-assessedFull detail
The primary outcome showed no statistically significant difference (adjusted risk ratio 1.36, 95% CI 0.92 to 2.02; P=0.12). The absolute difference was 8.3 percentage points, but the confidence interval includes zero and the study was powered to detect an 18% absolute risk reduction. The effect is not statistically supported and lacks clinical meaningfulness.
“adjusted risk ratio 1.36, 95% confidence interval 0.92 to 2.02; P=0.12; adjusted absolute difference 8.3 percentage points, 95% CI −3.8 to 20.4”
Find in source
03Printed percentage does not match its own count
mediumArithmeticrecomputedFull detail
3.1% does not match the reported count 3/104
“three (3.1%) in the control group”
ResultsFind in source
04Printed percentage does not match its own count
mediumArithmeticrecomputedFull detail
69% does not match the reported count 144/208
“basilar artery in 144 (69%) patients”
ResultsFind in source
05Printed percentage does not match its own count
mediumArithmeticrecomputedFull detail
5% does not match the reported count 10/208
“posterior cerebral artery in 10 (5%)”
ResultsFind in source
06Printed percentage does not match its own count
mediumArithmeticrecomputedFull detail
69% does not match the reported count 72/104
“Large artery atherosclerosis | 72 (69.0)”
Table 1Find in source

Findings by category

301ArithmeticNumerical inconsistencies 102OverreachOverstated conclusions 03AuthenticityNone found 104DisclosureReporting gaps 05AvailabilityNone found · partly checked 106CopyeditCopyediting

Numerical inconsistencies

3 findings · worst high

Summary statistic impossible for the stated N (GRIM/GRIMMER)Recomputed
Printed percentage does not match its own countRecomputed
Internal contradictions in the reported numbersAssessed

Overstated conclusions

1 finding · worst high

Treatment effect not shown to be clinically meaningfulAssessed

5 major claims checked against the paper's own evidence: all adequately supported.

Premise concern: effect size not shown to be clinically meaningful.

Data authenticity concerns

None found

Checked — nothing surfaced.

Reporting gaps

1 finding · worst medium

Data/code availability incompleteAssessed

Eight Dimensions7 pass · 1 warn

Sub-criteria

prior work citedADEQUATE

premise rationaleADEQUATE

limitations addressedADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

The premise is well-established with prior trials (CHOICE, ATTENTION) cited and a clear rationale for the study.

Evidence

Introduction ¶3Find in source

Introduction ¶2Find in source

“However, it remains uncertain whether this treatment approach could benefit patients with acute occlusions of the posterior circulation.”

Introduction ¶3Find in source

PASSReviewer 2· 90% conf

The paper establishes a clear scientific premise, citing prior work (CHOICE trial) and providing a logical rationale for the study.

Evidence

Introduction ¶3Find in source

Introduction ¶2Find in source

absence[Introduction]

Limitations of prior research are not explicitly discussed.

Sub-criteria

controlsN/A

power analysisADEQUATE

blinding levelsADEQUATE

outlier handlingINADEQUATE

randomization unitADEQUATE

inclusion exclusionADEQUATE

randomization methodADEQUATE

replicate distinctionN/A

independent replicationN/A

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 95% conf

The trial design is rigorous: randomised, open-label with blinded endpoint adjudication, pre-specified sample size, and clear inclusion/exclusion criteria.

Evidence

MethodsFind in source

“all research staff conducting telephone interviews and members of the independent endpoint adjudication committee were, however, masked to the treatment assignment.”

MethodsFind in source

PASSReviewer 2· 90% conf

The trial design is rigorous: randomised, with a clear randomization method, blinding of outcome assessors, a priori sample size calculation, and pre-specified inclusion/exclusion criteria.

Evidence

MethodsFind in source

“all research staff conducting telephone interviews and members of the independent endpoint adjudication committee were, however, masked to the treatment assignment.”

MethodsFind in source

Sub-criteria

demographicsADEQUATE

sex reportedADEQUATE

sex justifiedN/A

age weight healthADEQUATE

housing conditionsN/A

species strain sourceN/A

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

Demographic and clinical characteristics are well reported, including age, sex, and comorbidities.

Evidence

“The mean age was 66.0 (standard deviation 11.1) years, and 24.5% (n=51) were women.”

ResultsFind in source

“Mean (SD) age (years) | 65.0 (11.3) | 67.3 (10.8) | 0.17”

Table 1Find in source

PASSReviewer 2· 90% conf

Demographic and clinical characteristics are well reported, including age, sex, and key comorbidities.

Evidence

“The mean age was 66.0 (standard deviation 11.1) years, and 24.5% (n=51) were women.”

ResultsFind in source

“Mean (SD) age (years) | 65.0 (11.3) | 67.3 (10.8)”

Table 1Find in source

Sub-criteria

iacuc statementN/A

informed consentADEQUATE

irb ethics statementADEQUATE

regulatory complianceADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 95% conf

Ethical approval from a named committee and informed consent are documented.

Evidence

“Approved by the medical ethics committee of the First Affiliated Hospital of the University of Science and Technology of China and all relevant local ethics committees.”

EthicsFind in source

MethodsFind in source

“The trial was conducted in accordance to Good Clinical Practice and the Declaration of Helsinki.”

EthicsFind in source

PASSReviewer 2· 90% conf

Ethical approval and informed consent are adequately reported.

Evidence

“Approved by the medical ethics committee of the First Affiliated Hospital of the University of Science and Technology of China and all relevant local ethics committees.”

EthicsFind in source

paraphrase[Methods, Randomisation and masking]

“Once written informed consent had been obtained and successful endovascular recanalisation ... performed, patients were randomised”

“The trial was conducted in accordance to Good Clinical Practice and the Declaration of Helsinki.”

EthicsFind in source

Sub-criteria

mycoplasma testingN/A

reagents identifiedADEQUATE

organisms identifiedN/A

antibodies identifiedN/A

cell line authenticationN/A

software tools identifiedADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

The investigational product (tenecteplase) is identified with dose and regimen; statistical software is identified.

Evidence

MethodsFind in source

“All analyses were performed using STATA software, version 17.0.”

Statistical analysisFind in source

PASSReviewer 2· 90% conf

The investigational product (tenecteplase) is adequately identified, and statistical software is named.

Evidence

“Patients randomised to the tenecteplase group received an intra-arterial infusion of tenecteplase (0.0625 mg/kg, maximum dose 6.25 mg) through a distal access catheter or microcatheter”

MethodsFind in source

“All analyses were performed using STATA software, version 17.0.”

Statistical analysisFind in source

Sub-criteria

tests namedADEQUATE

exact p valuesADEQUATE

effect sizes ciADEQUATE

data presentationADEQUATE

software identifiedADEQUATE

assumptions verifiedADEQUATE

mathematical plausibilityPASS

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

Statistical methods are appropriate and well-described; effect sizes with confidence intervals are reported; no arithmetic errors detected.

Evidence

“A robust sandwich variance model was used to compare dichotomous outcomes: relative risk was estimated using the Poisson distribution with a log link function.”

Statistical analysisFind in source

“adjusted risk ratio 1.36, 95% confidence interval (CI) 0.92 to 2.02; P=0.12”

ResultsFind in source

“mRS score 0 or 1 at day 90† | 36 (34.6) | 27 (26.0) | RR | 1.33 (0.88 to 2.03) | 1.36 (0.92 to 2.02)”

Table 2Find in source

PASSReviewer 2· 90% conf

Statistical methods are appropriate and well described, with effect sizes and confidence intervals reported; p-values are exact where reported.

Evidence

“A robust sandwich variance model was used to compare dichotomous outcomes: relative risk was estimated using the Poisson distribution with a log link function.”

Statistical analysisFind in source

“adjusted risk ratio 1.36, 95% confidence interval (CI) 0.92 to 2.02; P=0.12”

ResultsFind in source

“mRS score 0 or 1 at day 90† | 36 (34.6) | 27 (26.0) | RR | 1.33 (0.88 to 2.03) | 1.36 (0.92 to 2.02)”

Table 2Find in source

Sub-criteria

code sharingN/A

accession numbersN/A

repository depositN/A

data availability statementINADEQUATE

Per reviewer (2) — the votes behind the verdict

WARNReviewer 1· 90% conf

A data availability statement exists but is vague ('on reasonable request' with no clear mechanism or timeframe).

Evidence

Data availabilityFind in source

WARNReviewer 2· 90% conf

A data availability statement exists but is vague, lacking a concrete access mechanism or timeframe.

Evidence

Data availabilityFind in source

Sub-criteria

funding coiADEQUATE

trial registrationADEQUATE

reporting guidelineNOT REPORTED

methods completenessADEQUATE

all outcomes reportedADEQUATE

limitations discussedADEQUATE

conclusions proportionalADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 95% conf

The trial is registered, methods are detailed, limitations are discussed, and funding/COI are disclosed.

Evidence

“Trial registration ClinicalTrials.gov NCT05684172 (https://clinicaltrials.gov/ct2/show/NCT05684172) .”

AbstractFind in source

“This study had several limitations. Firstly, as only patients from China were enrolled into the study, our results may not be generalisable to patients in western countries.”

LimitationsFind in source

“Funding: This study was funded by the Fundamental Research Funds for the Central Universities (YD9110002014).”

FundingFind in source

PASSReviewer 2· 90% conf

The manuscript is transparent: registered, reports all outcomes, discusses limitations, and provides funding/COI statements.

Evidence

“Trial registration ClinicalTrials.gov NCT05684172 (https://clinicaltrials.gov/ct2/show/NCT05684172)”

AbstractFind in source

“This study had several limitations. Firstly, as only patients from China were enrolled into the study, our results may not be generalisable to patients in western countries.”

LimitationsFind in source

“Funding: This study was funded by the Fundamental Research Funds for the Central Universities (YD9110002014).”

FundingFind in source

Registered (1 ID: ClinicalTrials.gov). No reporting guideline cited.

Broken references and links

None found · partly checked

References checked against Crossref, OpenAlex and Retraction Watch for retractions and resolvability, plus declared data and code links probed for whether they resolve to content matching the paper.

Nothing surfaced — but not everything feeding this category ran (missing: data/code link verification), so read this as a partial clean bill.

Checked 29 references by DOI: 28 verified — 1 no DOI (shown, not verified).

Copyediting

1 finding · worst low

Wording, consistency and formatting errors that need correcting before submission.

Wording or formatting errors that need correctingAssessed

6 copyedit issues flagged (1 major): mostly consistency, typo, grammar.

Kaimen Rigor Action ItemsFinal pass before journal submission

1.
HIGHreporting
Correct the per-protocol analysis percentage in Methods, Trial design: 206 out of 208 is 99%, not 81%. Verify the correct number or percentage.
This internal inconsistency is a factual error that could undermine reader trust and may warrant an erratum.
2.
HIGHreporting
Clarify the comparison in the Discussion statement about mRS 0-1 proportions (ATTENTION vs ATTENTION-IA): specify which group and time point are being compared.
The ambiguous comparison could mislead readers about the treatment effect.
3.
HIGHdata code
Improve the Data availability statement to specify a concrete access mechanism (e.g., a named repository or data access committee) and conditions/timeframe for data sharing.
The current 'on reasonable request' statement is vague and does not meet transparency standards for a data-driven trial.
4.
MEDIUMreporting
Explicitly state adherence to CONSORT reporting guidelines in the Methods or a separate section.
Explicit guideline adherence improves transparency and is expected for RCTs.
5.
MEDIUMrigor
Clarify outlier handling in the statistical analysis section, or state that no outliers were excluded.
The current reporting is ambiguous and could be misinterpreted.
6.
MEDIUMdata code
Add a statement about the availability of statistical analysis code, even if not shared, to clarify reproducibility.
Code availability is increasingly expected and clarifies reproducibility.
7.
MEDIUMstatistics
Report exact p-values for secondary outcomes where only CIs are given, to aid interpretation.
Exact p-values allow readers to assess statistical significance more precisely.
8.
LOWcopyedit
Fix the stray semicolon in the Abstract Results: change '36.4%; P=0.047' to '36.4%, P=0.047'.
Minor typographical error that should be corrected for clarity.
9.
LOWcopyedit
Capitalize 'All' at the start of the sentence in Methods, Randomisation and masking.
Sentence begins with lowercase 'all', which is a grammatical error.
10.
LOWreporting
Reconcile the reported adjusted absolute difference in the primary outcome: Results state 8.3 percentage points, Discussion states 7.6%. Clarify the discrepancy.
Minor internal inconsistency that could confuse readers.

Full text (49,779 chars)Analyzed: Aug 15, 2026