By Matthew E. Fink, MD

Professor and Chairman, Department of Neurology, Weill Cornell Medical College; Neurologist-in-Chief, New York Presbyterian Hospital

Dr. Fink reports he is a retained consultant for Procter & Gamble and Pfizer.

SOURCE: Van den berg LA, Dijkgraaf MG, Berhkemer OA, et al. Two-year outcome after endovascular treatment for acute ischemic stroke. N Engl J Med 2017;376:1341-1349.

In 2015, in the New England Journal of Medicine, these authors reported the 90-day outcomes of the Multicenter Randomized Clinical Trial of Endovascular Treatments for Acute Ischemic Stroke in the Netherlands (MR CLEAN), in which standard treatment was compared with endovascular treatment within six hours after onset of ischemic stroke symptoms. The trial showed that functional recovery at 90 days was better than intervention with standard treatment, specifically intravenous thrombolysis. Now the group reports the results of clinical follow-up at two years after randomization among the patients who were enrolled in the MR CLEAN trial.

Of the 500 patients who underwent randomization in the original trial, two-year data were available for 391. The distribution of outcomes on the modified Rankin scale favored endovascular treatments over conventional treatments (odds ratio = 1.68; 95% confidence interval, 1.15-2.45; P = 0.007). There were no significant differences between treatment groups in the percentage who had an excellent outcome, which is a Rankin score of 0 to 1. The cumulative two-year mortality was 26% in the intervention group and 31% in the control group, and was not significantly different. The authors concluded that the beneficial effects of endovascular treatments on functional outcome at two years in patients with acute ischemic stroke was similar to those reported at 90 days in the original trial.