The MRClean trial

On Dec 17th 2014, the NEJM published the results of MR CLEAN; a Dutch study comparing patients treated with intra-arterial thrombolysis to those of a medically managed cohort. The design of this trial was ingenious; focusing attention on patients who appeared to have failed intravenous thrombolysis. The IAT managed group performed quite favorably with respect to this control group. Three associate editors, Drs. Hirsch, Fiorella and Mocco discuss the impact of MR CLEAN and their personal loss of equipoise in this cohort of patients. Listeners to this podcast might enjoy the following articles, which have been published in JNIS that are referred to in the podcast. The Tribulations of Stroke Trials: http://jnis.bmj.com/content/5/3/181.long In search of the optimized stroke trial design. J Neurointerv Surg. 2014 May;6(4):249-51. doi: 10.1136/neurintsurg-2014-011204. A meta-analysis of prospective randomized controlled trials evaluating endovascular therapies for acute ischemic stroke. J Neurointerv Surg. 2015 Feb;7(2):84-9. doi: 10.1136/neurintsurg-2014-011543. Epub 2014 Nov 28. Endovascular therapy for acute ischemic stroke is indicated and evidence based: a position statement. J Neurointerv Surg. 2015 Feb;7(2):79-81. doi: 10.1136/neurintsurg-2014-011591. Epub 2014 Dec 18. A research roadmap of future endovascular stroke trials. J Neurointerv Surg. 2015 Feb;7(2):82-3. doi: 10.1136/neurintsurg-2014-011592. Epub 2014 Dec 18. No abstract available.