ISC 2015: Analysis of MR CLEAN Trial for Endovascular Therapy in Acute Ischemic Stroke

Dr. May Nour MD PhD Neurology Fellow UCLA Interview with:
Dr. May Nour MD PhD
Neurology Fellow

Medical Research: What is the background for this study? What are the main findings?

Dr. Nour: In October of 2014, results from the MR CLEAN trial were the first to demonstrate better functional outcomes in stroke patients as a result of endovascular therapy. Among patients whose stroke was caused by clot blocking a large vessel responsible for delivering blood to the vital tissue of the brain, the use of endovascular therapy, primarily utilizing second-generation clot retrieval devices, showed improved outcomes in most cases evaluated in combination with medical therapy, when compared to medical therapy alone. Currently, the standard of care involves delivery of intravenous tissue plasminogen activator (IV tPA) within a short time window (up to 3-4.5 hrs) with the intention of dissolving, rather than physically removing the clot as in the case of endovascular retrieval.

Medical Research: What should clinicians and patients take away from your report?

Dr. Nour: This analysis sought to capture the full magnitude of endovascular treatment effect in the MR CLEAN trial by calculating the number of patients needed to undergo endovascular therapy in order for there to be benefit or harm as a result of clot retrieval. The investigators found that endovascular therapy allows one additional patient to have fully restored neurologic function for every seven patients treated and one additional patient to have improved neurologic function for every 3-5 patients treated. It also showed that for every 100 patients treated with endovascular therapy, 14 more will have a nondisabled outcome and 22-29 will have a less disabled outcome, leading researchers to report the treatment effect as substantial in the MR CLEAN trial.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Nour: The published results of the trial taken together with this analysis, which further defines the magnitude of improvement in patient outcomes, is likely to herald a much anticipated paradigm shift in the clinical treatment of stroke caused by large vessel occlusion. This serves as a platform for us to continue to assess and understand patient selection for endovascular therapy and to determine which patients will benefit the most from this treatment.

Citation: International Stroke Conference  2015 abstract:

Presented by May Nour, MD
ISC 2015, Nashville, TN

Number Needed to Treat to Benefit and Harm for Endovascular Therapy in Acute Ischemic Stroke: Joint Outcome Table Analysis of the MR CLEAN Trial

[wysija_form id=”1″] Interview with:, Dr. May Nour MD PhD, Neurology Fellow, & UCLA (2015). ISC 2015: Analysis of MR CLEAN Trial for Endovascular Therapy in Acute Ischemic Stroke

Last Updated on February 15, 2015 by Marie Benz MD FAAD