On 2015 Feb 10, Diederik W J Dippel commented:

Dear dr Radecki, in my view the best way to synthesize evidence is the Cochrane collaboration's approach. They have done this for IV thrombolytic treatment and will quite likely update the review of intra-arterial treatment. I would highly recommend reading that report which will undoubtedly offer more insight and detail. Diederik Dippel

On 2015 Feb 06, Ryan Radecki commented:

Post-publication commentary: "MR-CLEAN & the New Golden Age"

I, among many others, have been highly skeptical of thrombolytic therapy and its role in the treatment of acute ischemic stroke. As has been well-documented, a few trials were positive, many were neutral, and a few were stopped early for harm or futility. To most of us, this indicates a therapy for whom only a small subset of those treated are ideal candidates for benefit, and the margin between benefit and harm is razor thin.

In my previous posts, I’ve sighed wistfully at the hope of The Next Big Thing in stroke treatment – local endovascular therapy, akin to percutaneous coronary intervention. However, each major endovascular trial published in the New England Journal last year failed to demonstrate benefit.

MR-CLEAN is different. MR-CLEAN is rather unambiguously positive. To be zero or minimally disabled? The endovascular intervention is favored 12% to 6%. “Functionally independent”, a modified Rankin Scale of 0-2, favors endovascular intervention 33% to 19%. A number needed to treat of, apparently, ~8 for independence is nothing to scoff at.

But why?...

http://www.emlitofnote.com/2014/12/mr-clean-new-golden-age.html

On 2015 Feb 06, Ryan Radecki commented:

Post-publication commentary: "MR-CLEAN & the New Golden Age"

I, among many others, have been highly skeptical of thrombolytic therapy and its role in the treatment of acute ischemic stroke. As has been well-documented, a few trials were positive, many were neutral, and a few were stopped early for harm or futility. To most of us, this indicates a therapy for whom only a small subset of those treated are ideal candidates for benefit, and the margin between benefit and harm is razor thin.

In my previous posts, I’ve sighed wistfully at the hope of The Next Big Thing in stroke treatment – local endovascular therapy, akin to percutaneous coronary intervention. However, each major endovascular trial published in the New England Journal last year failed to demonstrate benefit.

MR-CLEAN is different. MR-CLEAN is rather unambiguously positive. To be zero or minimally disabled? The endovascular intervention is favored 12% to 6%. “Functionally independent”, a modified Rankin Scale of 0-2, favors endovascular intervention 33% to 19%. A number needed to treat of, apparently, ~8 for independence is nothing to scoff at.

But why?...

http://www.emlitofnote.com/2014/12/mr-clean-new-golden-age.html

On 2015 Feb 10, Diederik W J Dippel commented:

Dear dr Radecki, in my view the best way to synthesize evidence is the Cochrane collaboration's approach. They have done this for IV thrombolytic treatment and will quite likely update the review of intra-arterial treatment. I would highly recommend reading that report which will undoubtedly offer more insight and detail. Diederik Dippel