MR CLEAN trial

The MR CLEAN trial was 16 center, randomized controlled trial conducted in the Netherlands on subjects presenting within 6 hours after onset of acute stroke syndrome, and confirmed large vessel occlusion in the anterior circulation. Subjects received endovascular thrombectomy (81.5% received stentriever devices) or standard of care. Of the 500 patients randomized, 445 (89%) were eligible and received IV alteplaseModified Rankin Scale at 3 months was the primary study endpoint; the rate of functional independence with intervention was 32.6% versus 19.1% with standard therapy.

MR CLEAN offers the first Level 1 evidence A evidence supporting mechanical thrombectomy for large-vessel ischemic stroke.

Confirmation of arterial occlusion and the superior technical performance of stentriever devices were decisive in this positive result.

The MR CLEAN trial establishes endovascular therapy as effective and safe for large-vessel anterior circulation stroke within 6 hours of symptom onset. This benefit was independent of intravenous thrombolysis 1)

1) Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJ, van Walderveen MA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle LJ, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van Rooij WJ, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach HZ, Marquering HA, Sprengers ME, Jenniskens SF, Beenen LF, van den Berg R, Koudstaal PJ, van Zwam WH, Roos YB, van der Lugt A, van Oostenbrugge RJ, Majoie CB, Dippel DW; MR CLEAN Investigators. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015 Jan 1;372(1):11-20. doi: 10.1056/NEJMoa1411587. Epub 2014 Dec 17. Erratum in: N Engl J Med. 2015 Jan 22;372(4):394. PubMed PMID: 25517348.

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