Endovascular Therapy Should Be Standard for Ischemic Stroke

Endovascular treatment for acute ischemic stroke (AIS) is as safe and effective in a real world setting as it has been shown to be in clinical trials, according to the results of a recent study.

In order to determine the safety and efficacy of endovascular treatment of AIS in routine clinical practice, researchers conducted an ongoing, prospective, observational cohort study involving 1488 patients included in the Multicentre Randomised Controlled Trial of Endovascular Treatment for Acute Ischaemic Stroke in the Netherlands (MR CLEAN) Registry who received endovascular treatment (stent retriever thrombectomy, aspiration, and all alternative methods for acute ischemic stroke) within 6.5 hours from the onset of symptoms.
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Outcomes in these patients were compared with those in patients who were randomly assigned to either endovascular therapy or usual care as part of the MR CLEAN clinical trial. They used a modified Rankin Scale (mRS) score ranging from 0 (no symptoms) to 6 (death) at 90 days after onset of symptoms as the primary outcome of the study.

Overall, patients who received endovascular therapy in the MR CLEAN registry had higher rates of better 90-day functional scores than patients who received endovascular therapy in the trial and controls, but 90-day mortality rates were higher among the registry patients than in trial endovascular or control patients.

“The findings confirm that endovascular treatment should be standard of care for patients with acute ischemic stroke due to proximal intracranial vessel occlusion in the anterior circulation,” the researchers concluded. 

—Michael Potts

Reference:

Jansen IGH, Mulder MJHL, Goldhoorn RB. Endovascular treatment for acute ischaemic stroke in routine clinical practice: prospective, observational cohort study (MR CLEAN Registry) [published online March 9, 2018]. BMJ. https://doi.org/10.1136/bmj.k949.