MR CLEAN: A Randomized Trial of Intra-arterial Treatment for Acute Ischemic Stroke

New England Journal of Medicine

The MR CLEAN trial was 16 center, randomized 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 alteplase.  Modified Rankin Score 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 1A 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.

Alexander A. Khalessi, MD