MR CLEAN Study Findings – Thrombolysis Before Thrombectomy in Stroke Patients?

Andrea Eberly, MD, MS, FAAEMBedside Diagnostic Challenge, Emergency Medicine, Family Medicine, Guideline Knowledge Check, Internal Medicine, Nurse Practitioner, Pediatric Emergency Medicine, Pediatric Medicine, Physician Assistant, Urgent Care

MR CLEAN Study, Thrombolysis Before Thrombectomy in Stroke Patients

MR CLEAN Study Findings - Thrombolysis Before Thrombectomy in Stroke Patients?

Andrea Eberly, MD, MS, FAAEM examines the recently published findings of the MR CLEAN study and the role of thrombolysis in patients with acute stroke who qualify for immediate thrombectomy.

In 2019, the American Heart Association (AHA) published stroke guidelines that for the first time fully integrated both medical (thrombolysis) and surgical methods (thrombectomy) for large cerebral vessel revascularization. This has resulted in a situation where patients who meet the criteria for both treatments now receive thrombolysis AND thrombectomy. 

What did the just published MR CLEAN study (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), discover with regards to the role of thrombolysis in patients with acute stroke who qualify for and have access to nearly immediate thrombectomy?

Try this case and test your knowledge of thrombolysis before thrombectomy in stroke patients.

A 73-year-old man presents to a stroke center with a 2-hour history of a large left-sided ischemic stroke in his anterior circulation.

His rapid work-up establishes that he is eligible for both thrombolysis and thrombectomy.

Both interventions are available without delay.

Question:

According to the November 2021 MR CLEAN study, how does skipping thrombolysis prior to thrombectomy in this case affect outcome?

Answer Options:

Skipping thrombolysis prior to thrombectomy is harmful because, though it does decrease the incidence of intracerebral hemorrhage, it also decreases the rate of successful recanalization and therefore the level of functional outcome to a statistically significant degree

Skipping thrombolysis prior to an emergently available thrombectomy is beneficial in terms of functional outcome because it decreases the incidence of intracerebral hemorrhage without adding ischemic time

Skipping thrombolysis prior to thrombectomy is beneficial in the subgroup of patients who have a < 60-minute door-to-intervention time, whereas it is harmful to patients who have a ≥ 60-minute door-to-intervention time

Skipping thrombolysis prior to thrombectomy is not beneficial in terms of functional outcome and the potential for harm cannot be excluded

See the Answer:

Dr. Andrea Eberly is one of the seasoned medical experts that contribute to Med-Challenger Medical Education products for medical board certification exam preparation, maintenance of medical certification, and continuing medical education requirements. 

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