{"id":46342,"date":"2014-12-17T15:27:15","date_gmt":"2014-12-17T20:27:15","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=news&p=46342"},"modified":"2014-12-17T15:27:15","modified_gmt":"2014-12-17T20:27:15","slug":"mr-clean","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2014\/12\/17\/mr-clean\/","title":{"rendered":"Dutch Trial Gives Support to Thrombectomy for Ischemic Stroke"},"content":{"rendered":"

A large new trial provides the first substantial evidence that thrombectomy may be beneficial in patients with acute ischemic stroke. Previous thromboectomy trials have been disappointing; some experts have speculated this may be due to the use of early-generation devices, long treatment delays, and difficulties in recruiting suitable patients into the trials.<\/p>\n

The Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN), published in the New England Journal of Medicine<\/em><\/a>,\u00a0was designed to address the limitations of previous trials. Some 500 patients with ischemic stroke were randomized to usual care or the addition of intraarterial treatment within 6 hours of symptom onset. Ninety percent of patients in both groups received intravenous alteplase before randomization. More than 80% of patients in the intraarterial treatment group were treated with a contemporary retrievable stent. Treatment was open label but the endpoint evaluation was blinded.<\/p>\n

There were significant differences between the groups in outcomes. For the primary outcome measure, there was a one-point reduction in the modified Rankin scale\u00a0at 90 days, from 4 in the control group to 3 in the treatment group. Some 32% of patients in the treatment group and 19% of patients in the control group were functionally independent (modified Rankin score, 0-2). The results were consistent across all prespecified subgroups.<\/p>\n

There was no difference in mortality between the groups. More patients in the treatment group had clinical signs of a second ischemic stroke in a different vascular territory (5.6% versus 0.4%).<\/p>\n

In addition to the use of retrievable stents, the authors speculated that a key factor in the success of intraarterial therapy in their trial was that all patients had a radiologically proven intracranial occlusion.<\/p>\n

In an accompanying editorial<\/a>, Werner Hacke praises the trial as a “first step in the right direction” but believes that it is too early to proclaim thrombectomy “the new standard treatment for severe stroke with proximal large-vessel occlusion up to 6 hours after stroke onset.” Several ongoing trials are still needed, he writes.<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

A large new trial provides the first substantial evidence that thrombectomy may be beneficial in patients with acute ischemic stroke. Previous thromboectomy trials have been disappointing; some experts have speculated this may be due to the use of early-generation devices, long treatment delays, and difficulties in recruiting suitable patients into the trials. The Multicenter Randomized […]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,9,16],"tags":[1334,253,2450],"class_list":["post-46342","post","type-post","status-publish","format-standard","hentry","category-general","category-interventional-cardiology","category-vascular","tag-ischemic-stroke","tag-stroke","tag-thrombectomy"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/46342","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=46342"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/46342\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=46342"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=46342"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=46342"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}