Danbot: Added Criticisms and Funding content

2026-03-21T22:43:39Z

Added Criticisms and Funding content

← Older revision		Revision as of 22:43, 21 March 2026
Line 78:		Line 78:

	==Criticisms & Further Discussion==		==Criticisms & Further Discussion==
			*Open-label study design may introduce performance and detection bias
			*Treatment effect was modest (absolute increase of 13.5% in functional independence at 90 days)
			*Endovascular treatment was performed relatively late (median time to groin puncture was 260 minutes from symptom onset)
			*Results may not be generalizable to centers without experienced neurointerventionalists
			*First-generation thrombectomy devices were predominantly used; newer stent retrievers may show greater benefit

	==External Links==		==External Links==
Line 84:		Line 89:

	==Funding==		==Funding==
			*Dutch Heart Foundation (Hartstichting)
			*Health Care Efficiency Research (ZonMw)
			*Additional unrestricted grants from multiple device manufacturers

	==References==		==References==

Danbot: Mark as Complete - article has all required sections

2026-03-21T22:12:06Z

Mark as Complete - article has all required sections

← Older revision		Revision as of 22:12, 21 March 2026
Line 13:		Line 13:
	\| fulltexturl=		\| fulltexturl=
	\| pdfurl=		\| pdfurl=
			\| status = Complete
	}}		}}
	==Clinical Question==		==Clinical Question==

Ostermayer: Ostermayer moved page MR CLEAN to EBQ:MR CLEAN

2026-03-21T22:06:18Z

Ostermayer moved page MR CLEAN to EBQ:MR CLEAN

← Older revision	Revision as of 22:06, 21 March 2026
(No difference)

ELEE1987: Created page with "{{JC info | title= Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands | abbreviation= MR CLEAN | expansion= | publis..."

2017-09-22T20:53:39Z

Created page with "{{JC info | title= Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands | abbreviation= MR CLEAN | expansion= | publis..."

New page

{{JC info
| title= Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands
| abbreviation= MR CLEAN
| expansion=
| published= January 1st, 2015
| author=
| journal= The New England Journal of Medicine
| year= 2015
| volume= 372
| issue= 1
| pages= 11-20
| pmid=
| fulltexturl=
| pdfurl=
}}
==Clinical Question==

Does endovascular intervention improve functional outcomes in patients with acute ischemic stroke secondary to large vessel occlusion in the anterior circulation?

==Conclusion==
Intraarterial treatment in select patients with AIS 2/2 proximal large vessel occlusion provides improved functional outcomes at 90 days.

==Major Points==
* 3 prior trials published in 2013 (IMS III, Synthesis EXP, MR RESCUE) showed no benefit of mechanical thrombectomy over tPA alone in AIS
* Improved functional outcomes at 90 days using MT +/- tPA in select patients with acute ischemic stroke
* No difference in mortality
* Proved safety with similar rates of symptomatic ICH
* Completion of this trial lead to interim analysis of similar trials and consequent closure (ESCAPE, EXTEND-1A, SWIFT PRIME, REVASCAT)
==Study Design==

* Prospective, Randomized multicenter trial
* tPA vs tPA + IAT in patients with AIS within 6 hours with LVO
* 16 hospitals in the Netherlands
* N=500
* 267 control cohort
* 233 interventional cohort

==Population==
* adults in the Netherlands
* Median age 65
* Median NIHSS 17 in interventional cohort, 18 in control
===Patient Demographics===
* Adults with acute ischemic stroke presenting under 6 hours in the Netherlands
===Inclusion Criteria===

* 18 years or older
* Acute ischemic stroke presenting within 6 hours of onset
* NIHSS 2+
* confirmed large vessel occlusion - ICA, M1 or M2

===Exclusion Criteria===
* Infarction in territory of occluded artery in past 6 weeks
* Plts <40k, INR >3, aPTT > 50
==Interventions==
* Intraarterial treatment
* Arterial catheterization with IA thrombolysis or mechanical thrombectomy or both
==Outcomes==
* Improved functional outcomes at 90 days in interventional group
* no significant difference in mortality
* no significant difference in occurrence of symptomatic intracranial hemorrhage

===Primary Outcome===
* Independent functional outcome at 90 days measured by modified Rankin Score system
* Absolute difference of 13.5 % between rates of functional independence (mRS 0-2)
* mRS (0-2) 32.6% intervention group
* mRS (0-2) 19.1% in control
===Secondary Outcomes===

* NIHSS at 24 hours, 5-7 days or at discharge
* Arterial recanalization at 24 hours by CTA/MRA
* Infarct size by CT at 5-7 days

===Subgroup analysis===

==Criticisms & Further Discussion==

==External Links==

==See Also==

==Funding==

==References==
<references/>

[[Category:EBQ]]

EBQ:MR CLEAN - Revision history

Danbot: Added Criticisms and Funding content

Danbot: Mark as Complete - article has all required sections

Ostermayer: Ostermayer moved page MR CLEAN to EBQ:MR CLEAN

ELEE1987: Created page with "{{JC info | title= Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands | abbreviation= MR CLEAN | expansion= | publis..."