title: Evolution of Intra-arterial Therapy for Acute Ischemic Stroke in The Netherlands: MR CLEAN Pretrial Experience.
abstract: BACKGROUND
  The Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands (MR CLEAN) trial showed efficacy of intra-arterial (IA) treatment in acute ischemic stroke (AIS). We studied the evolution of IA treatment for AIS and its effects on clinical outcome and recanalization in The Netherlands in the pre-MR CLEAN era.
  
  
  METHODS
  Data on 517 patients with AIS treated with IA therapy were collected retrospectively from all intervention centers in The Netherlands from 2002 to the start of participation in the MR CLEAN trial. Clinical outcome was measured by means of the modified Rankin Scale score and recanalization with the Thrombolysis in Cerebral Infarction Scale.
  
  
  RESULTS
  IA therapy was first used in patients with basilar artery occlusion. Over the years, there was a gradual increase in the number of anterior circulation strokes treated. There was a shift in applied therapies from primary IA therapy to combined intravenous and IA therapy and from IA thrombolysis to mechanical thrombectomy. Time from symptom onset to treatment decreased. Recanalization rates gradually increased. At the same time, there was a trend toward more favorable outcomes after 3 months and fewer deceased patients both at discharge and after 3 months. However, none of these changes reached statistical significance.
  
  
  CONCLUSIONS
  The treatment approach used in the MR CLEAN trial was the result of an evolution of practise in the preceding years, with gradual improvement in technical and clinical outcomes.
authors.affiliation: Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands. Electronic address: a.rozeman@gmail.com.
authors.forename: Anouk D
authors.initials: AD
authors.lastname: Rozeman
authors.affiliation: Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Marieke J H
authors.initials: MJ
authors.lastname: Wermer
authors.affiliation: Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Jan Albert
authors.initials: JA
authors.lastname: Vos
authors.affiliation: Department of Radiology, Medical Center Haaglanden, The Hague, The Netherlands.
authors.forename: Geert J
authors.initials: GJ
authors.lastname: Lycklama à Nijeholt
authors.affiliation: Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Debbie
authors.initials: D
authors.lastname: Beumer
authors.affiliation: Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Olvert A
authors.initials: OA
authors.lastname: Berkhemer
authors.affiliation: Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Diederik W J
authors.initials: DW
authors.lastname: Dippel
authors.affiliation: Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Ale
authors.initials: A
authors.lastname: Algra
authors.affiliation: Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands.
authors.forename: Jelis
authors.initials: J
authors.lastname: Boiten
authors.affiliation: Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Neurology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Wouter J
authors.initials: WJ
authors.lastname: Schonewille
mesh_terms: D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery; D002543:Cerebral Hemorrhage / Q000139:chemically induced; D003131:Combined Modality Therapy; D016208:Databases, Factual; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000009:adverse effects; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017131:Thrombectomy / Q000009:adverse effects / Q000295:instrumentation / Q000706:statistics & numerical data / Q000639:trends; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000706:statistics & numerical data / Q000639:trends*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000209:etiology
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Intra-arterial therapy; acute stroke therapy; stroke; thrombectomy