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A Randomized Trial of Intravenous Alteplase before Endovascular Treatment for Stroke

By Currents Editor posted 12-10-2021 11:29


A Randomized Trial of Intravenous Alteplase before Endovascular Treatment for Stroke

New England Journal of Medicine (11/11/21) DOI: 10.1056/NEJMoa2107727

LeCouffe, Natalie E.; Kappelhof, Manon; Treurniet, Kilian M.; et al.


The MR CLEAN-NO IV randomized study, conducted in Europe, evaluated the benefit of administering I.V. alteplase ahead of endovascular treatment (EVT) for acute ischemic stroke. The final analysis involved 539 patients, with half receiving usual care (EVT after I.V. alteplase) and half receiving EVT only. The main efficacy endpoint, assessed at 90 days, was functional outcome as measured on the modified Rankin scale. The primary safety endpoints were all-cause mortality and symptomatic intracerebral hemorrhage. With a score of 0 denoting no disability at all and a score of 6 representing death, modified Rankin scale readings at follow-up were a median of 2 in the cohort that was subject to standard care and 3 in the group that received EVT alone. The finding suggests EVT by itself is no better or no worse than I.V. alteplase followed by EVT in terms of disability outcome 90 days post-stroke. Mortality was higher in the EVT-only group, at 20.5% vs. 15.8%, but the cohorts registered similar rates of intracerebral hemorrhage.


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