Large artery occlusions of the anterior circulation represent a common and severely debilitating form of ischemic stroke. In addition, IV tPA has limited ability to recanalize such proximal occlusions of the intracranial arteries. Prior to the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN), three randomized controlled trials (RCTs) using intraarterial (IA) therapies (MR RESCUE, IMS III, and SYNTHESIS Expansion) had failed to show a benefit on functional outcomes. In the design of MR CLEAN, the authors speculated that improved patient selection and newer endovascular devices would improve outcomes.

To assess whether IA treatment added to IV tPA improves functional outcomes in patients with ischemic strokes secondary to occlusion of the proximal anterior circulation.

Multicenter, randomized blinded end-point evaluation trial conducted at 16 centers in the Netherlands between December 2010 and March 2014.