ArticleTrials2021
MR CLEAN-NO IV: intravenous treatment followed by endovascular treatment versus direct endovascular treatment for acute ischemic stroke caused by a proximal intracranial occlusion-study protocol for a randomized clinical trial.
Article in Trials, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 2 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
38 citing papers in PubMed, 2 syntheses or guidelines pooled it, 58 citations in OpenAlex.
- Thrombectomy with or without thrombolysis in patients with acute ischemic stroke: a systematic review and meta-analysis.Journal of neurology · 2022Pooled it
- Mechanical Thrombectomy With and Without Intravenous Tissue Plasminogen Activator for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis Using Nested Knowledge.Frontiers in neurology · 2021Pooled it
- Effect of Perforator Territory Infarction on Functional Outcome in Patients With Large Vessel Occlusion.Stroke · 2025Trial
- Time to Endovascular Treatment and Clinical Outcome in Acute Ischemic Stroke With M2-Segment Occlusion.Journal of the American Heart Association · 2025Trial
- Role of intravenous alteplase on late lesion growth and clinical outcome after stroke treatment.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2023Trial
- Admission blood pressure and clinical outcomes in patients with acute ischaemic stroke treated with intravenous alteplase and endovascular treatment versus endovascular treatment alone: A MR CLEAN-NO IV substudy.European stroke journal · 2023Trial
- Infarct Evolution in Patients with Anterior Circulation Large-Vessel Occlusion Randomized to IV Alteplase and Endovascular Treatment versus Endovascular Treatment Alone.AJNR. American journal of neuroradiology · 2023Trial
- Endovascular thrombectomy for stroke due to medium vessel occlusion: a meta-analysis of randomized controlled trials.Annals of medicine and surgery (2012) · 2026Article
- Accuracy of Distal Internal Carotid Artery Contrast Ratio to Infer Proximal Carotid Disease in the Mobile Stroke Unit.Stroke (Hoboken, N.J.) · 2026Article
- Automated collateral assessment restricted to the hypoperfused area for distal vessel occlusions in ischemic stroke.European radiology · 2025Article
- Neighborhood Socioeconomic Status and the Functional Outcome of Patients Treated With Endovascular Thrombectomy for Ischemic Stroke.Neurology · 2025Article
- M2 vessel occlusion characteristics and outcome after endovascular therapy: A post-hoc pooled analysis of MR CLEAN MED, NO-IV and LATE.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2025Article
- Subacute edema progression after acute ischemic stroke: impact of intravenous alteplase administration and reperfusion degree.Frontiers in neurology · 2025Article
- Direct endovascular treatment may be more appropriate for patients with good collateral circulation: a retrospective case-control study.Quantitative imaging in medicine and surgery · 2024Article
- Predictors of outcome and symptomatic intracranial hemorrhage in acute basilar artery occlusions: Analysis of the PC-SEARCH thrombectomy registry.European stroke journal · 2024Article
- Type of intracranial hemorrhage after endovascular stroke treatment: association with functional outcome.Journal of neurointerventional surgery · 2023Article
- Association between computed tomography perfusion and the effect of intravenous alteplase prior to endovascular treatment in acute ischemic stroke.Neuroradiology · 2023Article
- Perceived acceptable uncertainty regarding comparability of endovascular treatment alone versus intravenous thrombolysis plus endovascular treatment.Journal of neurointerventional surgery · 2023Article
- Direct Mechanical Thrombectomy vs. Bridging Therapy in Stroke Patients in A "Stroke Belt" Region of Southern Europe.Journal of personalized medicine · 2023Article
- Time dependency of automated collateral scores in computed tomography angiography and computed tomography perfusion images in patients with intracranial arterial occlusion.Neuroradiology · 2023Article
Corrections and comments
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Authors and funding
19 authors at 7 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEndovascular treatment (EVT) has greatly improved the prognosis of acute ischemic stroke (AIS) patients with a proximal intracranial large vessel occlusion (LVO) of the anterior circulation. Currently, there is clinical equipoise concerning the added benefit of intravenous alteplase administration (IVT) prior to EVT. The aim of this study is to assess the efficacy and safety of omitting IVT before EVT in patients with AIS caused by an anterior circulation LVO.
methodsMR CLEAN-NO IV is a multicenter randomized open-label clinical trial with blinded outcome assessment (PROBE design). Patients ≥ 18 years of age with a pre-stroke mRS < 3 with an LVO confirmed on CT angiography/MR angiography eligible for both IVT and EVT are randomized to receive either IVT (0.9 mg/kg) followed by EVT, or direct EVT in a 1:1 ratio. The primary objective is to assess superiority of direct EVT. Secondarily, non-inferiority of direct EVT compared to IVT before EVT will be explored. The primary outcome is the score on the modified Rankin Scale at 90 days. Ordinal regression with adjustment for prognostic variables will be used to estimate treatment effect. Secondary outcomes include reperfusion graded with the eTICI scale after EVT and stroke severity (National Institutes of Health Stroke Scale) at 24 h. Safety outcomes include intracranial hemorrhages scored according to the Heidelberg criteria. A total of 540 patients will be included. DISCUSSION: IVT prior to EVT might facilitate early reperfusion before EVT or improved reperfusion rates during EVT. Conversely, among other potential adverse effects, the increased risk of bleeding could nullify the beneficial effects of IVT. MR CLEAN-NO IV will provide insight into whether IVT is still of added value in patients eligible for EVT.
trial registrationwww.isrctn.com : ISRCTN80619088 . Registered on 31 October 2017.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.