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{{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]]