n - RESCUe - RESUVal

Funded by the Dutch Heart Foundation. Nominal, unrestricted .... Adjusted cOR 2·49, 95% CI 1·76–3·53; p
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Strokecenter

Key lessons of MR CLEAN study

Diederik Dippel

Disclosures

Funded by the Dutch Heart Foundation Nominal, unrestricted grants from • AngioCare BV

• Medtronic/Covidien/EV3® • MEDAC Gmbh/LAMEPRO • Penumbra Inc. • Top Medical/Concentric • Stryker

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4

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Where in the world is The Netherlands?

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Where in the world is The Netherlands?

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Where in the world is The Netherlands?

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Where in the world is The Netherlands?

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Where in the world is The Netherlands?

Total N

16,920,700

Population density 1050 / sq mile

Autostrada

3025 miles

Autostrada density

94 miles/1000 sq miles

Hospitals

90

Intervention centers

16

Acute ischemic stroke

20,000 / year 10

Published randomized trials of intra-arterial treatment  1st wave: PROACT I and PROACT II • Landmark studies

• Intra-arterial thrombolytics and guidewire manipulation  2nd wave: IMS III, MR RESCUE and SYNTHESIS • Larger studies

• Mechanical devices

3d wave studies MR CLEAN, ESCAPE, EXTEND IA, REVASCAT, SWIFT PRIME, THERAPY, THRACE, PISTE • 2nd generation mechanical devices: retrievable stents • 1 study used aspiration only

• Restricted time window • Confirmed thromboembolic intracranial occlusion • Some kind of patient selection

Why start a new trial in 2010? • Improved patient selection through widespread availability of CTA

• Fast access to treatment through good infrastructure

• Availability of promising new treatment modality: Retrievable stents 13

The studies: size and inclusion / exclusion criteria Trial

N

Time window

Age limit

NIHSS

Collateral score

Penumbra

Ischemic core

Thrombus length

MR CLEAN

500

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ESCAPE

315