Endovascular treatment versus no endovascular treatment after 6–24 h in patients with ischaemic stroke and collateral flow on CT angiography (MR CLEAN-LATE) in the Netherlands: a multicentre, open-label, blinded-endpoint, randomised, controlled, phase 3 trial

Olthuis, Susanne G H; Pirson, Anne; Pinckaers, Florentina M E; Hinsenveld, Wouter H.; Nieboer, Daan; Ceulemans, Angelique; Knapen, Robrecht R. M. M.; Robbe, M M Quirien; Berkhemer, Olvert A.; Walderveen, Marianne A.A. van; Nijeholt, Geert J. Lycklama à; Uyttenboogaart, Maarten; Schonewille, Wouter J.; Sluijs, P Matthijs van der; Wolff, Lennard; Voorst, Henk van; Postma, Alida A.; Roosendaal, Stefan D.; Hoorn, Anouk van der; Emmer, Bart J.; Krietemeijer, Menno; Doormaal, Pieter‐Jan van; Roozenbeek, Bob; Goldhoorn, Robert‐Jan B.; Staals, Julie; Ridder, Inger R. de; Leij, Christiaan van der; Coutinho, Jonathan M.; Worp, H. Bart van der; Lo, Rob T.H.; Bokkers, Reinoud P H; Dijk, Ewoud I van; Boogaarts, Hieronymus D.; Wermer, Marieke J.H.; Es, Adriaan C G M van; Tuijl, Julia H. van; Kortman, Hans; Gons, Rob A.R.; Yo, Lonneke S.F.; Vos, Jan‐Albert; Laat, Karlijn F. de; Dijk, Lukas C. van; Wijngaard, Ido R. van den; Hofmeijer, Jeannette; Martens, Jasper M.; Brouwers, P. J. A. M.; Bulut, Tomas; Remmers, Michel J M; Jong, Thijs E A M de; Hertog, Heleen M. den; Hasselt, Boudewijn A.A.M. van; Rozeman, Anouk D.; Elgersma, Otto E. H.; Veen, Bas van der; Sudiono, Davy R; Lingsma, Hester F.; Roos, Yvo B.W.E.M.; Majoie, Charles B. L. M.; Lugt, Aad van der; Dippel, Diederik W.J.; Zwam, Wim H. van; Oostenbrugge, Robert J. van

doi:10.1016/s0140-6736(23)00575-5

Cited by 109 publications

(47 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The DAWN and DEFUSE-3 trials demonstrated the efficacy of mechanical thrombectomy in the extended time window up to 24 hours from time last seen well. The MR CLEAN LATE, 8 CLEAR, 34 and RESCUE BT studies 33 showed that selection of patients to EVT in the late window can be performed by evaluation of a good NCCT and/or good collaterals on CTA, particularly in light of the positive results from the large ischemic core trials. The performance of such imaging paradigms is more widely available and accessible compared with advanced imaging techniques.…”

Section: Discussionmentioning

confidence: 99%

“…The MR CLEAN LATE trial demonstrated better outcomes in patients treated with EVT in mRS ordinal shift analysis. 8 Other trials including RESILIENT Extend (NCT02216643) and NO-CTP (NCT05230914) will also evaluate the use of NCCT for patient selection to EVT in the late window.…”

Section: Neuroimaging Selection In the Late Time Windowmentioning

confidence: 99%

“…Across multiple randomized clinical trials in the early and late window, recanalization has been proven to improve functional outcomes. 5 6 7 8…”

mentioning

confidence: 99%

See 2 more Smart Citations

Endovascular Thrombectomy for Anterior Circulation Large Vessel Occlusion Stroke: An Evolution of Trials

Starikova,

Räty,

Strbian

et al. 2023

Semin Neurol

View full text Add to dashboard Cite

The last decade's progress in demonstrating the clinical benefit of endovascular thrombectomy (EVT) in patients with large vessel occlusion stroke has transformed the paradigm of care for these patients. This review presents the milestones in implementing EVT as standard of care, demonstrates the current state of evidence, provides guidance for identifying the candidate patient for EVT, and highlights unsolved and controversial issues. Ongoing trials investigate broadening of EVT indications for patients who present with large core infarction, adjunctive intra-arterial thrombolysis, medium vessel occlusion, low NIHSS, and tandem occlusion.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Neuroimaging Selection In the Late Time Windowmentioning

confidence: 99%

See 1 more Smart Citation

Endovascular Thrombectomy for Anterior Circulation Large Vessel Occlusion Stroke: An Evolution of Trials

Starikova,

Räty,

Strbian

et al. 2023

Semin Neurol

View full text Add to dashboard Cite

show abstract

“…However, these recommendations may change based on the results of recently completed and ongoing large core studies. [8][9][10] The routine use of multimodal imaging offers additional advantages in stroke research based on a survey of the workshop participants. For example, at comprehensive stroke centers, the routine use of multimodal imaging is recommended to facilitate endovascular stroke research aimed at refining EVT eligibility criteria (eg, There is no consensus of the optimal imaging protocol for primary and comprehensive stroke centers.…”

Section: Special Reportmentioning

confidence: 99%

Priorities for Advancements in Neuroimaging in the Diagnostic Workup of Acute Stroke

Samaniego,

Boltze,

Lyden

et al. 2023

Stroke

View full text Add to dashboard Cite

STAIR XII (12th Stroke Treatment Academy Industry Roundtable) included a workshop to discuss the priorities for advancements in neuroimaging in the diagnostic workup of acute ischemic stroke. The workshop brought together representatives from academia, industry, and government. The participants identified 10 critical areas of priority for the advancement of acute stroke imaging. These include enhancing imaging capabilities at primary and comprehensive stroke centers, refining the analysis and characterization of clots, establishing imaging criteria that can predict the response to reperfusion, optimizing the Thrombolysis in Cerebral Infarction scale, predicting first-pass reperfusion outcomes, improving imaging techniques post-reperfusion therapy, detecting early ischemia on noncontrast computed tomography, enhancing cone beam computed tomography, advancing mobile stroke units, and leveraging high-resolution vessel wall imaging to gain deeper insights into pathology. Imaging in acute ischemic stroke treatment has advanced significantly, but important challenges remain that need to be addressed. A combined effort from academic investigators, industry, and regulators is needed to improve imaging technologies and, ultimately, patient outcomes.

show abstract

“…However, because of the very large treatment effect observed in these trials and the quite strict penumbral imaging criteria used, it has been hypothesized that patients presenting in the late window with broader imaging criteria could benefit from EVT. Recently, the MR CLEAN-LATE trial showed a substantial benefit of EVT vs. best medical management alone in AIS-LVO admitted in the 6–24 h time-window with collateral flow on CT-angiography, but who otherwise did not meet the imaging criteria used in the DAWN and DEFUSE 3 trials [46 ▪▪ ]. The therapeutic effect observed in MR CLEAN-LATE was lower than that observed in DEFUSE 3 and DAWN, which suggests that perfusion imaging identifies better candidates for reperfusion therapies, but current criteria may be too stringent and may miss patients who still derive substantial benefit from EVT.…”

Section: Introductionmentioning

confidence: 99%

Does imaging of the ischemic penumbra have value in acute ischemic stroke with large vessel occlusion?

Seners,

Baron,

Olivot

et al. 2023

Current Opinion in Neurology

View full text Add to dashboard Cite

Purpose of review In this review, we summarize current evidence regarding potential benefits and limitations of using perfusion imaging to estimate presence and extent of irreversibly injured ischemic brain tissue (‘core’) and severely ischemic yet salvageable tissue (‘penumbra’) in acute stroke patients with large vessel occlusion (LVO). Recent findings Core and penumbra volumes are strong prognostic biomarkers in LVO patients. Greater benefits of both intravenous thrombolysis and endovascular therapy (EVT) are observed in patients with small core and large penumbra volumes. However, some current definitions of clinically relevant penumbra may be too restrictive and exclude patients who may benefit from reperfusion therapies. Alongside other clinical and radiological factors, penumbral imaging may enhance the discussion regarding the benefit/risk ratio of EVT in common clinical situations, such as patients with large core – for whom EVT's benefit is established but associated with a high rate of severe disability –, or patients with mild symptoms or medium vessel occlusions – for whom EVT's benefit is currently unknown. Beyond penumbral evaluation, perfusion imaging is clinically relevant for optimizing patient's selection for neuroprotection trials. Summary In an emerging era of precision medicine, perfusion imaging is a valuable tool in LVO-related acute stroke.

show abstract

Endovascular treatment versus no endovascular treatment after 6–24 h in patients with ischaemic stroke and collateral flow on CT angiography (MR CLEAN-LATE) in the Netherlands: a multicentre, open-label, blinded-endpoint, randomised, controlled, phase 3 trial

Cited by 109 publications

References 31 publications

Endovascular Thrombectomy for Anterior Circulation Large Vessel Occlusion Stroke: An Evolution of Trials

Endovascular Thrombectomy for Anterior Circulation Large Vessel Occlusion Stroke: An Evolution of Trials

Priorities for Advancements in Neuroimaging in the Diagnostic Workup of Acute Stroke

Does imaging of the ischemic penumbra have value in acute ischemic stroke with large vessel occlusion?

Contact Info

Product

Resources

About