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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe MR CLEAN trial evaluates the effect of intra-arterial intervention in proximal anterior circulation acute ischemic stroke. Endovascular therapy within 6 hours of onset improves functional outcomes compared with standard guideline stroke treatment. Intervention is beneficial, in particular, to patients older than 80 years and those in the lower modified NIH Stroke Scale categories.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EIntra-arterial intervention\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eendovascular therapy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eproximal intracranial arterial occlusion\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eacute ischemic stroke\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Emodified Rankin Scale\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMR CLEAN\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EISRCTN10888758\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eneurology clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecerebrovascular disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventional techniques \u0026amp; devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eischemia\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EDiederik Dippel, MD, PhD, Erasmus University Medical Center, Rotterdam, the Netherlands, presented updated data from MR CLEAN, a multicenter randomized clinical trial of endovascular treatment for acute ischemic stroke (AIS) in the Netherlands [\u003Ca href=\u0022\/external-ref?link_type=ISRCTN\u0026amp;access_num=ISRCTN10888758\u0022 class=\u0022external-ref external-ref-type-isrctn\u0022\u003EISRCTN10888758\u003C\/a\u003E]. The results demonstrated improved functional outcomes in patients who received endovascular therapy up to 6 hours after stroke onset in the proximal anterior circulation, in addition to best medical care [Berkhemer OA et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2015].\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EAccording to Prof Dippel, more than one-third of patients with AIS have a proximal intracranial arterial occlusion. Intravenous (IV) administration of tissue plasminogen activator (tPA) within 4.5 hours of stroke onset clears the blockage in only about one-third of these and leads to recovery in only 10%.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EAlthough previous trials showed no effect of intra-arterial treatment on functional outcomes in AIS, a new study was needed, he stressed, owing to improved patient selection from widespread use of computed tomography, rapid access to treatment in the Netherlands, and new endovascular treatment modalities. Prof Dippel and colleagues therefore conducted MR CLEAN to evaluate the effect of intra-arterial treatment on functional outcome in AIS, on a background of best medical management.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EThe open-label trial [Berkhemer OA et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2015] included 500 patients (\u2265\u200518 years) with AIS with cranial arterial anterior circulation occlusion that was confirmed on imaging and could be treated intra-arterially within 6 hours of symptom onset. NIH Stroke Scale (NIHSS) scores were \u2265\u20052. The primary outcome was the score on the modified Rankin Scale (mRS) at 90 days.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EParticipants received usual care (which could include IV alteplase) and were randomized to also receive either intra-arterial intervention (n\u2005=\u2005233) or no additional treatment (n\u2005=\u2005267). The time from onset to groin puncture in the intervention group was 260 minutes.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EPatients in the intervention group had lower mRS categories, consistent with improved function, at 90 days (adjusted OR, 1.67; 95% CI, 1.21 to 2.30; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/9\/7.2\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Effect of Endovascular Intervention on Functional Outcome at 90 DaysFrom N Engl J Med, Berkhemer OA et al., A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke, Volume No. 372, 11-20. Copyright \u0026#xA9; (2015) Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-893061328\u0022 data-figure-caption=\u0022\u0026amp;lt;div xmlns=\u0026amp;quot;http:\/\/www.w3.org\/1999\/xhtml\u0026amp;quot;\u0026amp;gt;Effect of Endovascular Intervention on Functional Outcome at 90 DaysFrom \u0026amp;lt;em\u0026amp;gt;N Engl J Med\u0026amp;lt;\/em\u0026amp;gt;, Berkhemer OA et al., A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke, Volume No. 372, 11-20. Copyright \u0026#xA9; (2015) Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society.\u0026amp;lt;\/div\u0026amp;gt;\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/9\/7.2\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/9\/7.2\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/9\/7.2\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16580\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EEffect of Endovascular Intervention on Functional Outcome at 90 Days\u003C\/p\u003E\n               \u003Cp id=\u0022p-9\u0022\u003EFrom \u003Cem\u003EN Engl J Med\u003C\/em\u003E, Berkhemer OA et al., A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke, Volume No. 372, 11-20. Copyright \u00a9 (2015) Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EProf Dippel also highlighted unpublished subanalyses from MR CLEAN. Intra-arterial intervention was superior to no additional treatment for all age groups in the study, in particular, for those aged \u2265\u200580 years (adjusted OR, 3.24; 95% CI, 1.22 to 8.62), and for those with the most severe strokes (NIHSS score\u2005\u2265\u200520; adjusted OR, 1.85; 95% CI, 1.06 to 2.31).\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003ECompared with controls, intra-arterial intervention with local anesthesia (adjusted OR, 2.79; 95% CI, 1.70 to 4.59) was more likely to result in a good outcome than general anesthesia (adjusted OR, 1.09; 95% CI, 0.56 to 2.12), which showed no benefit over usual care.\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EProf Dippel concluded that intra-arterial intervention on a background of usual best stroke care is effective and safe in many patients if provided within 6 hours of stroke onset.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/9\/7.2.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzlns1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlns1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}