https://orcid.org/0000-0001-5816-2481
Peer Review History
| Original SubmissionJune 6, 2024 |
|---|
|
PONE-D-24-23084Prevalence of spontaneous recanalization of extracranial internal carotid occlusion: a systematic scoping reviewPLOS ONE Dear Dr. Zhang, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Nov 23 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript:
If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols . We look forward to receiving your revised manuscript. Kind regards, Atakan Orscelik Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. 3. As required by our policy on Data Availability, please ensure your manuscript or supplementary information includes the following: A numbered table of all studies identified in the literature search, including those that were excluded from the analyses. For every excluded study, the table should list the reason(s) for exclusion. If any of the included studies are unpublished, include a link (URL) to the primary source or detailed information about how the content can be accessed. A table of all data extracted from the primary research sources for the systematic review and/or meta-analysis. The table must include the following information for each study: Name of data extractors and date of data extraction Confirmation that the study was eligible to be included in the review. All data extracted from each study for the reported systematic review and/or meta-analysis that would be needed to replicate your analyses. If data or supporting information were obtained from another source (e.g. correspondence with the author of the original research article), please provide the source of data and dates on which the data/information were obtained by your research group. If applicable for your analysis, a table showing the completed risk of bias and quality/certainty assessments for each study or outcome. Please ensure this is provided for each domain or parameter assessed. For example, if you used the Cochrane risk-of-bias tool for randomized trials, provide answers to each of the signalling questions for each study. If you used GRADE to assess certainty of evidence, provide judgements about each of the quality of evidence factor. This should be provided for each outcome. An explanation of how missing data were handled. This information can be included in the main text, supplementary information, or relevant data repository. Please note that providing these underlying data is a requirement for publication in this journal, and if these data are not provided your manuscript might be rejected. 4. We note that there is identifying data in the Supporting Information file <Zhang_SR_data export_v2.xlsx>. Due to the inclusion of these potentially identifying data, we have removed this file from your file inventory. Prior to sharing human research participant data, authors should consult with an ethics committee to ensure data are shared in accordance with participant consent and all applicable local laws. Data sharing should never compromise participant privacy. It is therefore not appropriate to publicly share personally identifiable data on human research participants. The following are examples of data that should not be shared: -Name, initials, physical address -Ages more specific than whole numbers -Internet protocol (IP) address -Specific dates (birth dates, death dates, examination dates, etc.) -Contact information such as phone number or email address -Location data -ID numbers that seem specific (long numbers, include initials, titled “Hospital ID”) rather than random (small numbers in numerical order) Data that are not directly identifying may also be inappropriate to share, as in combination they can become identifying. For example, data collected from a small group of participants, vulnerable populations, or private groups should not be shared if they involve indirect identifiers (such as sex, ethnicity, location, etc.) that may risk the identification of study participants. Additional guidance on preparing raw data for publication can be found in our Data Policy (https://journals.plos.org/plosone/s/data-availability#loc-human-research-participant-data-and-other-sensitive-data) and in the following article: http://www.bmj.com/content/340/bmj.c181.long. Please remove or anonymize all personal information (<specific identifying information in file to be removed>), ensure that the data shared are in accordance with participant consent, and re-upload a fully anonymized data set. Please note that spreadsheet columns with personal information must be removed and not hidden as all hidden columns will appear in the published file. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: No ********** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A Reviewer #2: Yes ********** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ********** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ********** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The authors conducted a scoping review of studies reporting spontaneous recanalisation after ICA occlusion. This subject is interesting and refers to an entity that is otherwise underestimated in the literature. Though interesting the study presents some major limitations. The main limitation is the heterogeneity regarding the included studies. Case series most often report spontaneous recanalisation in individuals who come with symptom recurrence or new events. On the other hand, prospective studies or RCTs have a more "strict" protocol of follow up imaging. Combining these disparate approaches to estimate prevalence might be confusing. Another drawback is that it refers to ICA occlusion in general. This combines both occlusion caused by a dissection and occlusion due to atherothrombosis. These are entirely distinct entities with well documented natural history. They will,in my opinion, be handled and reported separately. More specifically, the occurrence of spontaneous recanalisation of an occlusion due to an underlying atherosclerotic plaque is a rare event for which there is a dearth of information and recommendations. Reviewer #2: The possibility of spontaneous recanalization of an occluded internal carotid artery (ICA) has been known for years. The challenge lies not in the fact of recanalization itself but in determining the management strategy after its detection and its impact on the patient's neurological condition. The article lacks basic data on the neurological status of patients at the time of occlusion diagnosis, the onset of neurological symptoms during the occlusion, and after the confirmation of recanalization. These are key pieces of information when discussing this topic. Please establish the neurological history of the patients analyzed. Page 11; Line 117 The material includes acute, subacute, and chronic ICA occlusions. The mechanism of spontaneous recanalization differs across these subgroups, as do the prognosis and treatment approaches. Do the authors have data that would allow for a separate analysis of these subgroups? Page 12; Line 134 Imaging of extracranial ICA occlusion in the context of spontaneous recanalization requires information on the patency of this artery in the intracranial segments as well. DUS examination is performed to assess the C1 segment. In CTA, the site of restored circulation in the ICA is often not visible. The reference examination for assessing the length of ICA occlusion is selective angiography from the contralateral artery. Do the authors have data regarding the length of ICA occlusion? Do the authors have data on whether the spontaneous recanalization manifested as, for example, a string sign, complete recanalization, or significant stenosis in the C1 segment? Page 13; Line 154 The surgical management of patients with spontaneous recanalization requires information on the nature of the stenosis. Did the intervention methods, such as CEA, CAS, or lack thereof, pertain to patients after acute or chronic occlusions? What types of stenoses were they? What were the outcomes of the surgical treatments? Page 15; Line 207 Conclusions On what basis did the authors conclude that patients with spontaneous recanalization who underwent surgery benefited from this approach? ********** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy . Reviewer #1: Yes: Klearchos Psychogios Reviewer #2: No ********** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step. |
| Revision 1 |
|
PONE-D-24-23084R1Prevalence of spontaneous recanalization of extracranial internal carotid occlusion: a systematic scoping reviewPLOS ONE Dear Dr. Zhang, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Feb 16 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript:
If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols . We look forward to receiving your revised manuscript. Kind regards, Atakan Orscelik Academic Editor PLOS ONE [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #3: All comments have been addressed Reviewer #4: All comments have been addressed Reviewer #5: (No Response) ********** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #3: Yes Reviewer #4: Yes Reviewer #5: No ********** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #3: N/A Reviewer #4: No Reviewer #5: No ********** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #3: Yes Reviewer #4: Yes Reviewer #5: Yes ********** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #3: Yes Reviewer #4: Yes Reviewer #5: Yes ********** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: All previous comments were addressed by the authors in the revised manuscript. The manuscript has been significantly enhanced. Reviewer #3: The authors have responded to the multiple reviewer questions and concerns, particularly regarding to the limitations of the source data. Reviewer #4: This systematic scoping review of spontaneous recanalization following extracranial ICA occlusion has important limitations. The significant heterogeneity in reporting and identifying ICA recanalization events, due to the lack of a standard timeline for surveillance imaging after carotid occlusion, limits the strength of the conclusions. The majority of recanalizations were identified secondary to symptomatic recurrent clinical events, potentially biasing the results towards symptomatic cases, particularly in case reports. There is also a possibility that some cases reported as occlusion on non-invasive imaging may have been near occlusions with trickle flow. Additionally, the scoping review design provides limited data on the exact morphology of spontaneous recanalization, such as thrombus length and radiological markers. The study combines occlusions caused by dissection and atherothrombosis, which are distinct entities with different natural histories that should ideally be analyzed separately. A prospective cohort study with prespecified imaging protocols is ultimately needed to reduce heterogeneity and confirm these findings. Reviewer #5: COMMENTS: Zhang and colleagues present a literature review to inform an important clinical question: is occluded internal carotid artery really a benign finding i.e. safe to not offer intervention as one would for a high grade stenosis? This is an interesting and valuable attempt at quantifying the prevalence of spontaneous extracranial ICA recanalization, but it has some important weaknesses that are largely addressed by the original reviewers. I note that I am not one of the original reviewers but am considering the comments of and responses to the original reviewers in my assessment. The concerns I have are really the same. These are addressed, I think, with modest effort given the apparent limitations of the underlying data, which is largely to say that the authors could do very little to address these concerns. Thus, my foremost recommendation would be to further temper the discussion of the manuscript to a level appropriate for data that is, at best, suggestive of the conclusions drawn. I acknowledge that it is not the fault of the authors that the underlying data may be of poor quality or not particularly informative for clinical use, but it is the responsibility of the authors to find diamonds in the rough that will justify their proposed prospective cohort study. There is a substantial amount of work to be done for this manuscript to be interpretable. Major points 1. I have a hard time believing that there is no data on neurological status available in any of the manuscripts reviewed. Any information would be helpful here and would be of value to answer the fundamental question: does it matter whether an artery spontaneously recanalizes? Yes, such a patient would then meet criteria for intervention if symptomatic in a technical sense but a chronic occlusion from atherosclerotic disease versus a dynamic dissection flap is an extremely different pathology with different risk of presenting future neurologic complications. The authors at least once say most presentations for recanalization were at symptom onset with no further information provided. This is contradictory and confusing and undermines my confidence in the manuscript. 2. As a consequence of point 1), this study lacks the granularity I would expect of a scoping review that included 53 studies, even if the majority of them were case studies. 3. I do think this review article can be salvaged but it requires the addition of a section in the results section discussing the above-mentioned points, and major rewriting of discussion and restructuring of figures. 4. Consolidate figures 2 and 3 into one figure, use the additional figure space to illustrate some of the more specific data reviewers 1 and 2 had asked about. Detailed points Reviewer Comments Reviewer #1 • Comment #1 Response: How can you estimate prevalence from a case series if cases are selected based on the occurrence of spontaneous recanalization? The denominator of this calculation is nebulous at best. • Comment #2: the difference between recanalization and after occlusion due to dissection vs atherosclerotic plaque was not sufficiently discussed. Reviewer #2 • Comment #1: Question about impact on patient’s neurological condition. This is a comment that could have and should have been addressed in more detail here and is reiterated in greater detail by this reviewer in comment #2. This is the fundamental underlying question of this work and needs to be reasoned through and answered as much as is possible with the available data. • Comment #3 response: I appreciate the researchers including this reference to planned prospective cohort study. However, simply suggesting a possible future study is insufficient. At the very least, I would expect a detailed and candid discussion of the things that cannot be addressed in this review. • Comment #4 response: Agree with report results of commenting on recanalization morphology in the results section, this would be interesting. Given alleged 40% prevalence from the case series evaluated, I would be very surprised that zero of them had e.g. angiographic descriptions. • Comment #5 response: This information, regarding acuity/chronicity, is interesting and valuable and should be included in the main body of the text • Comment #6 response: There are studies that comment on the significance of spontaneous recanalization that can and should be cited here Methods Lines 66-67: There must have been more exclusion criteria to lose so many (96% to be exact) of your harvested studies in the search process. If additional criteria were used, please specify these explicitly in the text. Results Lines 100-105: I am extremely suspicious that patient age and sex were not recorded in so many of these studies. These are very basic demographics and the lack of recording, suggest poor-quality evidence. This alone may be disqualifying for this manuscript if fundamental sociodemographics are not available from the studies. Line 106: The meaning of "specified dissection" is not clear to me? I.e., 17 studies listed cases of dissection or 17 included it as a category regardless of whether those participants were included or not. Lines 119-120: Please comment on the relative frequencies of symptomatic presentation vs routine check-up diagnoses. Line 122-3: Please re-word. “Time frame in cohort studies” is total time of follow up or is time to recanalization? Line 142: Without additional imaging modalities or could one patient have more than one imaging modality? If yes, were both counted in this review or how was decided which one was counted? Line 158: Are these participants? Of how many total? Lines 161-162: Lack of neurological data is again concerning re: underlying data. I think for a neurovascular pathology with intervention criteria defined by symptomatology, this again may be a disqualification of the manuscript. Discussion Line 179: I do not think the authors can say this likely occurs in more than 20% of cases. I think this is statement that must be tempered substantially if not entirely removed. The number of excluded studies and the opacity of the denominator in these data do not allow the authors to say this. The authors could rephrease to a “We calculate an estimated XX% incidence of recanalization based on our extremely low quality data”. Lines 180-182: The authors must temper this statement. They are suggesting a high cost and potential intervention (which is a non-zero risk of major procedural complications up to and including stroke, MI, or death) based on low quality data. Line 184: The majority of studies in this review were also case studies. The authors should make it clear that their estimate of prevalence is also mostly derived from case studies. Lines 189-191: You should cite directly from the trial not just from a secondary review Line 199: “Given that most of the cases included in this study presented symptomatically either at occlusion or recanalization…” Suggests strongly that the authors do have this data. What were the symptoms? If only from case series, that is fine but is critical and would be informative. Line 203: “there is case report-level evidence” change to "there are case reports of successful revascularization..." Line 220: “the majority of cases used the diagnostic gold standard of angiography“ As per Tables, the majority of patients were diagnosed via ultrasound unless multiple modalities were counted more than once Line 229: 21.2% - What is this number derived from? Tables Table 2: In part A, the numbers for pre- (n=54) and post-recanalization (n=53) don't match. Where does the missing study belong? Figures Figure 1: Records excluded are very high. Please specify why these records were excluded. Figure 2: This is not a good graph because there is so much overlap between datapoints and is very challenging to interpret. There is also a tremendous amount of white space in the figures. Consider alternative designs such as cumulative incidence functions. Figure 3: Maybe I am misunderstanding but it seems that this is the same information that is presented in figure 2 and thus is totally unnecessary. If these are different, it needs to be made clearer how these are different data. ********** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy . Reviewer #1: Yes: Klearchos Psychogios Reviewer #3: No Reviewer #4: Yes: Robert J. Chen, MD, MPH Reviewer #5: No ********** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step. |
| Revision 2 |
|
PONE-D-24-23084R2Prevalence of spontaneous recanalization of extracranial internal carotid occlusion: a systematic scoping reviewPLOS ONE Dear Dr. Zhang, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by May 08 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript:
If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols . We look forward to receiving your revised manuscript. Kind regards, Atakan Orscelik Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #4: All comments have been addressed ********** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #4: Yes ********** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #4: Yes ********** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #4: Yes ********** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #4: Yes ********** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #4: This scoping review addresses an important clinical question; however, several specific limitations require revision. First, the heterogeneity in imaging modalities and timing of recanalization assessment significantly weakens conclusions. Clarify how multiple imaging modalities per patient were handled statistically to avoid double-counting. Second, combining dissections with atherothrombotic occlusions is problematic given distinct natural histories; separate analyses or subgroup sensitivity analyses are recommended. Third, the prevalence calculation from case series is questionable due to unclear denominators; restrict prevalence estimates to cohort studies only. Fourth, neurological outcomes and symptomatology at recanalization are inadequately detailed; explicitly report symptomatic versus asymptomatic presentations. Finally, the discussion overstates findings; temper conclusions to reflect the hypothesis-generating nature of data. ********** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy . Reviewer #4: Yes: Robert J. Chen, MD, MPH ********** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step. |
| Revision 3 |
|
PONE-D-24-23084R3Prevalence of spontaneous recanalization of extracranial internal carotid occlusion: a systematic scoping reviewPLOS ONE Dear Dr. Zhang, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by May 29 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript:
If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols . We look forward to receiving your revised manuscript. Kind regards, Atakan Orscelik Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #4: All comments have been addressed ********** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #4: Yes ********** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #4: Yes ********** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #4: Yes ********** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #4: Yes ********** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #4: The authors have made commendable revisions in response to prior concerns; however, some issues persist. While imaging heterogeneity is acknowledged, the handling of multiple modalities per patient remains insufficiently clarified—quantifying per study rather than per patient risks duplication bias. Although dissection and non-dissection etiologies are now separated, the categorization could benefit from consistent application and clearer definitions across analyses. Prevalence estimates have appropriately excluded case series; this correction improves methodological rigor. Neurological outcomes and symptom status at recanalization are partially addressed but remain underreported—explicit patient-level counts and clinical context are needed. Finally, despite some moderation, elements of the discussion continue to imply clinical applicability beyond the scope of this review; further tempering is warranted. Overall, the manuscript addresses an important gap, but further revision is necessary to ensure analytical precision and appropriate interpretation of results. ********** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy . Reviewer #4: Yes: Robert J. Chen, MD, MPH ********** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step. |
| Revision 4 |
|
PONE-D-24-23084R4Prevalence of spontaneous recanalization of extracranial internal carotid occlusion: a systematic scoping reviewPLOS ONE Dear Dr. Zhang, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Jun 28 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript:
If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols . We look forward to receiving your revised manuscript. Kind regards, Atakan Orscelik Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #4: All comments have been addressed ********** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #4: Partly ********** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #4: Yes ********** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #4: Yes ********** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #4: Yes ********** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #4: This scoping review addresses an important topic but has several methodological and interpretive limitations. The authors pool heterogeneous studies (cohorts and case reports) without adequate weighting or bias assessment, making the reported “prevalence” (median ~21%) potentially misleading. Inclusion criteria and definitions (true occlusion vs high-grade stenosis, and recanalization threshold) should be clarified. Different imaging modalities (Doppler US, CTA, angiography) and variable follow-up intervals are not accounted for, raising detection bias. Statistical reporting relies on unweighted descriptive metrics without confidence intervals or heterogeneity analysis. There is no appraisal of study quality or publication bias. Case reports inherently bias timing and frequency; the claim that recanalization is more common than thought seems overstated. Study-level data (sample sizes, recanalization counts) should be reported, and a meta-analytic or weighted approach considered to provide confidence intervals. Overall conclusions must be tempered given these limitations. ********** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy . Reviewer #4: Yes: Robert J. Chen, MD, MPH ********** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step. |
| Revision 5 |
|
Spontaneous recanalization of extracranial internal carotid occlusion: a systematic scoping review PONE-D-24-23084R5 Dear Dr. Zhang, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Atakan Orscelik Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: |
| Formally Accepted |
|
PONE-D-24-23084R5 PLOS ONE Dear Dr. Zhang, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Atakan Orscelik Academic Editor PLOS ONE |
Open letter on the publication of peer review reports
PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.
We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.
Learn more at ASAPbio .