New Trials

MR CLEAN

• Multi-center RCT in Netherlands, funded by Covidien
• Diagnosed lesion on MRA, CTA, DSA
• NIHSS score (11 items)
• Primary: modified Rankin Score at 90 days - measure of ADLs
• Euro QoL5D
• Intervention within 4 hours
• 82% used stent retriever
• Limits: sick control group

ESCAPE trial

• Canada
• Anterior circulation
• High functioning at baseline
• Treatment within 12 hours
• Excluded large infarct
• No difference in ICH
• 59% vs 22% functional independence
• NNT = 4.2

EXTEND-IA

• Reperfusion at 24 hours
• Neuro improvement at day 3
• 100% reperfusion vs 37% with tPA alone
• 71% vs 40%
• NNT = 3.2
• Halted early (70 patients)
• Generalizes only to 10% of stroke patients (very few people eligible for tPA)

SWIFT-PRIME trial

• Primary: 90 day mRS
• 196 patients
• Confirmed findings (better reperfusion, better functional independence)
• No difference in mortality or hemorrhage

Trials in patients who cannot have tPA

REVASCAT

• Twice as many patients achieved functional independence

Conclusions

These studies show that intervention works.

• Give tPA within first 4.5 hours
• Up to 6 hours, endovascular treatment is safe and effective
• Evidence is strongest with small infarct cores, proximal occlusions