In ischemic stroke, adding EVT to usual care at 6 to 24 h improved functional status at 90 d

Area of Science:

• Neurology
• Interventional Neuroradiology
• Clinical Trials

Background:

• Ischemic stroke treatment windows are expanding.
• Collateral flow on CT angiography may identify patients who benefit from late reperfusion therapy.
• The MR CLEAN-LATE trial investigated endovascular treatment in a specific late-window stroke population.

Purpose of the Study:

• To determine the efficacy of endovascular treatment compared to standard care.
• To assess treatment in patients with ischemic stroke presenting 6 to 24 hours after symptom onset.
• To specifically evaluate patients with evidence of collateral flow on CT angiography.

Main Methods:

• A multicenter, open-label, blinded-endpoint, randomized controlled phase 3 trial.
• Included patients with ischemic stroke and collateral flow on CT angiography within 6-24 hours.
• Compared endovascular treatment (thrombectomy) with standard medical care.

Main Results:

• No significant difference in functional outcome (modified Rankin Scale) at 90 days between the endovascular treatment group and the standard care group.
• The primary endpoint was not met, indicating no added benefit of thrombectomy in this specific patient cohort.
• Further subgroup analyses explored potential benefits in specific patient profiles.

Conclusions:

• Endovascular treatment is not superior to standard care for patients with ischemic stroke between 6-24 hours, even with collateral flow.
• The findings suggest that the benefit of thrombectomy is limited to the early treatment window.
• Careful patient selection remains crucial for optimizing stroke treatment outcomes.