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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.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\u003EResults from the MR CLEAN clinical trial demonstrated that intra-arterial treatment within 6 hours of stroke onset in patients with acute ischemic stroke due to intracranial anterior occlusion was safe and effective at significantly reducing disability at 90 days, infarct volume at 7 days, and residual occlusion at 24 hours poststroke.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eacute ischemic stroke\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eendovascular\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Edisability\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einfarct volume\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eintra-arterial\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMR CLEAN\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eresidual occlusion\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EYvo B. Roos, MD, PhD, University of Amsterdam, Amsterdam, the Netherlands, presented the results from the MR CLEAN trial [Berkhemer OA et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2015], which demonstrated, for the first time, the safety and efficacy of intra-arterial treatment within 6 hours of stroke onset in patients with acute ischemic stroke caused by intracranial anterior circulation occlusion.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EMR CLEAN was a multicenter, randomized, prospective, open-label, phase 3 trial with blinded assessment conducted in the Netherlands. Eligible patients were aged \u2265\u200918 years with a National Institutes of Health Stroke Scale (NIHSS) score of \u2265\u20092, who had an acute ischemic stroke due to intracranial anterior circulation occlusion and received treatment within 6 hours from stroke onset.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EIntra-arterial intervention consisted of arterial catheterization with a microcatheter to the level of the intracranial arterial occlusion, followed by delivery of a thrombolytic agent, mechanical treatment, or both (the method was left to the discretion of the treating physician). The primary outcome was the score on the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included neuroimaging of arterial recanalization at 24 hours and the final infarct volume at 7 days.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EThe study enrolled a total of 500 patients (233 in the intervention group, 267 in the control group). The main clinical characteristics, including the mean age and NIHSS score, at baseline were similar between the groups. Intra-arterial therapy was performed in 196 of the 233 patients within the intervention group. Retrievable stents were used in 190 of these patients (97%), other devices were used in 5 patients (2.6%), and only 1 patient (0.4%) received thrombolytic treatment alone.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EThe primary outcome analysis revealed that there was a shift in the distribution of the mRS scores at 90 days in favor of the intervention (OR, 1.67; 95% CI, 1.21 to 2.30), which was consistent for all mRS categories except death (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). The distribution of mRS scores of 6 (death) were similar in both groups.\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\/2\/14\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022mRS Score Distribution at 90 DaysmRS, modified Rankin Scale.From N Engl J Med, Berkhemer OA et al, Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke, 2015;372:11-20. Copyright \u0026#xA9; Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1065820652\u0022 data-figure-caption=\u0022\u0026amp;lt;div xmlns=\u0026amp;quot;http:\/\/www.w3.org\/1999\/xhtml\u0026amp;quot;\u0026amp;gt;mRS Score Distribution at 90 DaysmRS, modified Rankin Scale.From \u0026amp;lt;em\u0026amp;gt;N Engl J Med\u0026amp;lt;\/em\u0026amp;gt;, Berkhemer OA et al, Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke, 2015;372:11-20. Copyright \u0026#xA9; 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\/2\/14\/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\/2\/14\/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\/2\/14\/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\/15259\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-7\u0022 class=\u0022first-child\u0022\u003EmRS Score Distribution at 90 Days\u003C\/p\u003E\n               \u003Cp id=\u0022p-8\u0022\u003EmRS, modified Rankin Scale.\u003C\/p\u003E\n               \u003Cp id=\u0022p-9\u0022\u003EFrom \u003Cem\u003EN Engl J Med\u003C\/em\u003E, Berkhemer OA et al, Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke, 2015;372:11-20. Copyright \u00a9 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\u003EComputed tomographic angiography at 24 hours demonstrated that residual occlusion at the target site could not be detected in 75.4% of patients in the intervention group vs 32.9% in the control group (OR, 6.9; 95% CI, 4.3 to 10.9). The between-group difference in the final infarct volume at 7 days also favored the intervention group (19 mL; 95% CI, 4 to 34). The NIHSS score at 7 days was, on average, 2.9 points lower in the intervention group than in the control group (95% CI, 1.5 to 4.3). Prespecified subgroup analyses demonstrated that the treatment effect remained consistent regardless of age, NIHSS score, time from onset to randomization, and other criteria.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EThere was no significant difference between the intervention and the control group in the occurrence of serious adverse events, such as parenchymal hemorrhage type 2, pneumonia, and hemicraniectomy. The only notable difference was a higher incidence of new ischemic stroke in different vascular territory in the intervention group (5.6%) vs the control group (0.4%); however, according to Prof Roos, that is an expected adverse effect of mechanical intervention.\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\/2\/14.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?nzlr0p\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?nzlr0p\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}