In Western Europe and the US, the annual incidence of ischemic stroke is 1-2 per 1000. Half of all patients with stroke die or remain severely disabled. Treatment with intravenous (IV) alteplase, aiming at early reperfusion has been proven effective for these patients, when they are treated within 4.5 hours, and when there are no contra-indications. In about one third of the patients with acute anterior circulation ischemic stroke, symptoms are caused by a proximal occlusion of one of the major intracranial arteries. IV alteplase only leads to recanalization in up to 33% of these patients. In those without recanalization, outcome is generally poor.
Recently, the results of MR CLEAN and 4 other international randomized controlled trials on intra-arterial therapy (IAT) in proximal anterior circulation stroke were published (EXTEND-IA, ESCAPE, SWIFT-PRIME and REVASCAT), all of them confirming the safety and efficacy of IAT and its importance for the advancement of stroke care. This has resulted in a strong momentum swing, with clinicians and researchers worldwide now targeting ways to further improve IAT effectiveness. Recent American and Canadian guidelines have already been updated stating that IAT should be standard of care for eligible patients. (AHA/ASA and Canadian) With proof of a beneficial effect now available, the full implementation and integration of IAT in the Dutch health care system has started. The Dutch ministry of health has pledged to provisionally reimburse IAT. However, until 2016, this will only be done in the context of the MR CLEAN-R.
The purpose of the MR CLEAN-R: A post-trial Registry of the Multicenter Randomized Clinical trial of Intra-arterial treatment for acute ischemic stroke in the Netherlands is to monitor implementation and safety of IAT in all patients and further study prognostic factors and outcome in a well-defined set of patients according to explicit criteria, comparable to the MR CLEAN trial population.