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Abstract

Background:

The aim of the current study was to assess the influence of anesthetic management on the effect of treatment in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN).

Methods:

MR CLEAN was a multicenter, randomized, open-label trial of intra-arterial therapy (IAT) vs no IAT. The intended anesthetic management at the start of the procedure was used for this post hoc analysis. The primary effect parameter was the adjusted common odds ratio (acOR) for a shift in direction of a better outcome on the modified Rankin Scale (mRS) at 90 days, estimated with multivariable ordinal logistic regression analysis, which included a term for general anesthesia (GA).

Results:

GA was associated with significant (p = 0.011) effect modification, resulting in estimated decrease of 51% (95% confidence interval [CI] 31%–86%) in treatment effect compared to non-GA. We found a shift in the distribution on the mRS in favor of non-GA compared to control group (acOR 2.18 [95% CI 1.49–3.20]). The shift in distribution between GA and control group was in a similar direction (acOR 1.12 [95% CI 0.71–1.78]) with loss of statistical significance.

Conclusions:

In this post hoc analysis, we found that the type of anesthetic management influences outcome following IAT. Only treatment without general anesthesia was associated with a significant treatment benefit in MR CLEAN.

Classification of evidence:

This study provides Class II evidence that for patients with acute ischemic stroke undergoing IAT, mRS scores at 90 days improve only in patients treated without GA.

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Information & Authors

Information

Published In

Neurology®
Volume 87Number 7August 16, 2016
Pages: 656-664
PubMed: 27421546

Publication History

Received: October 19, 2015
Accepted: March 7, 2016
Published online: July 15, 2016
Published in print: August 16, 2016

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Disclosure

O. Berkhemer, L. van den Berg, P. Fransen, and D. Beumer report no disclosures relevant to the manuscript. A. Yoo received grant support from Penumbra. H. Lingsma and W. Schonewille report no disclosures relevant to the manuscript. R. van den Berg received consulting fees from Codman/DePuy Synthes. M. Wermer reports no disclosures relevant to the manuscript. J. Boiten received honoraria for his role as a consultant for Boehringer Ingelheim. G. Lycklama à Nijeholt, P. Nederkoorn, M. Hollmann, W. van Zwam, A. van der Lugt, and R. van Oostenbrugge report no disclosures relevant to the manuscript. C. Majoie's institution received fees for his role as a consultant for Stryker (speakers bureau/lecture fees). D. Dippel and Y. Roos report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.

Study Funding

This study was partly funded by the Dutch Heart Foundation and through unrestricted grants from AngioCare BV, Covidien/EV3, MEDAC GmbH/LAMEPRO, and Penumbra Inc. MR CLEAN is registered under number NTR1804 in the Dutch trial register and under ISRCTN10888758 in the ISRCTN register.

Authors

Affiliations & Disclosures

Olvert A. Berkhemer, MD*
From the Departments of Radiology (O.A.B., R.v.d.B., C.B.L.M.M.), Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.), and Anesthesiology (M.W.H.), Academic Medical Center, Amsterdam; Departments of Radiology (P.S.S.F., A.v.d.L.), Neurology (O.A.B., P.S.S.F., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam; Departments of Radiology (W.H.v.Z.) and Neurology (D.B., R.J.v.O.), Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), the Netherlands; Division of Neurointervention (A.J.Y.), Texas Stroke Institute, Plano; Department of Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein; Department of Neurology (M.J.H.W.), Leiden University Medical Center; and Departments of Neurology (J.B.) and Radiology (G.J.L.à.N.), MC Haaglanden, the Hague, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Lucie A. van den Berg, MD*
From the Departments of Radiology (O.A.B., R.v.d.B., C.B.L.M.M.), Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.), and Anesthesiology (M.W.H.), Academic Medical Center, Amsterdam; Departments of Radiology (P.S.S.F., A.v.d.L.), Neurology (O.A.B., P.S.S.F., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam; Departments of Radiology (W.H.v.Z.) and Neurology (D.B., R.J.v.O.), Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), the Netherlands; Division of Neurointervention (A.J.Y.), Texas Stroke Institute, Plano; Department of Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein; Department of Neurology (M.J.H.W.), Leiden University Medical Center; and Departments of Neurology (J.B.) and Radiology (G.J.L.à.N.), MC Haaglanden, the Hague, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
ZonMw, 837004005, funded the long term follow-up and cost- effectiveness study of the MR CLEAN (CLOT-MR CLEAN, NTR5073), 2012.
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Puck S.S. Fransen, MD
From the Departments of Radiology (O.A.B., R.v.d.B., C.B.L.M.M.), Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.), and Anesthesiology (M.W.H.), Academic Medical Center, Amsterdam; Departments of Radiology (P.S.S.F., A.v.d.L.), Neurology (O.A.B., P.S.S.F., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam; Departments of Radiology (W.H.v.Z.) and Neurology (D.B., R.J.v.O.), Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), the Netherlands; Division of Neurointervention (A.J.Y.), Texas Stroke Institute, Plano; Department of Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein; Department of Neurology (M.J.H.W.), Leiden University Medical Center; and Departments of Neurology (J.B.) and Radiology (G.J.L.à.N.), MC Haaglanden, the Hague, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Debbie Beumer, MD
From the Departments of Radiology (O.A.B., R.v.d.B., C.B.L.M.M.), Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.), and Anesthesiology (M.W.H.), Academic Medical Center, Amsterdam; Departments of Radiology (P.S.S.F., A.v.d.L.), Neurology (O.A.B., P.S.S.F., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam; Departments of Radiology (W.H.v.Z.) and Neurology (D.B., R.J.v.O.), Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), the Netherlands; Division of Neurointervention (A.J.Y.), Texas Stroke Institute, Plano; Department of Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein; Department of Neurology (M.J.H.W.), Leiden University Medical Center; and Departments of Neurology (J.B.) and Radiology (G.J.L.à.N.), MC Haaglanden, the Hague, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Albert J. Yoo, MD
From the Departments of Radiology (O.A.B., R.v.d.B., C.B.L.M.M.), Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.), and Anesthesiology (M.W.H.), Academic Medical Center, Amsterdam; Departments of Radiology (P.S.S.F., A.v.d.L.), Neurology (O.A.B., P.S.S.F., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam; Departments of Radiology (W.H.v.Z.) and Neurology (D.B., R.J.v.O.), Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), the Netherlands; Division of Neurointervention (A.J.Y.), Texas Stroke Institute, Plano; Department of Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein; Department of Neurology (M.J.H.W.), Leiden University Medical Center; and Departments of Neurology (J.B.) and Radiology (G.J.L.à.N.), MC Haaglanden, the Hague, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
(1)Penumbra, Inc., research meeting for THERAPY trial, 2014, (2)Neuravi, Inc., imaging core lab research meeting for ARISE II trial, 2015
Editorial Boards:
1.
Journal of Neuroimaging, editorial board, 2014-6
Patents:
1.
NONE
Publishing Royalties:
1.
Neuroradiology Cases, Oxford University Press, 2012
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
Neuravi
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
Texas Stroke Institute, neurointerventional procedures, 100%, 2015-present
Research Support, Commercial Entities:
1.
(1)Penumbra, Inc., (2)Neuravi, Inc.
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Hester F. Lingsma, MD, PhD
From the Departments of Radiology (O.A.B., R.v.d.B., C.B.L.M.M.), Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.), and Anesthesiology (M.W.H.), Academic Medical Center, Amsterdam; Departments of Radiology (P.S.S.F., A.v.d.L.), Neurology (O.A.B., P.S.S.F., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam; Departments of Radiology (W.H.v.Z.) and Neurology (D.B., R.J.v.O.), Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), the Netherlands; Division of Neurointervention (A.J.Y.), Texas Stroke Institute, Plano; Department of Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein; Department of Neurology (M.J.H.W.), Leiden University Medical Center; and Departments of Neurology (J.B.) and Radiology (G.J.L.à.N.), MC Haaglanden, the Hague, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Wouter J. Schonewille, MD, PhD
From the Departments of Radiology (O.A.B., R.v.d.B., C.B.L.M.M.), Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.), and Anesthesiology (M.W.H.), Academic Medical Center, Amsterdam; Departments of Radiology (P.S.S.F., A.v.d.L.), Neurology (O.A.B., P.S.S.F., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam; Departments of Radiology (W.H.v.Z.) and Neurology (D.B., R.J.v.O.), Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), the Netherlands; Division of Neurointervention (A.J.Y.), Texas Stroke Institute, Plano; Department of Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein; Department of Neurology (M.J.H.W.), Leiden University Medical Center; and Departments of Neurology (J.B.) and Radiology (G.J.L.à.N.), MC Haaglanden, the Hague, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
The Netherlands Heart Foundation
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
René van den Berg, MD, PhD
From the Departments of Radiology (O.A.B., R.v.d.B., C.B.L.M.M.), Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.), and Anesthesiology (M.W.H.), Academic Medical Center, Amsterdam; Departments of Radiology (P.S.S.F., A.v.d.L.), Neurology (O.A.B., P.S.S.F., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam; Departments of Radiology (W.H.v.Z.) and Neurology (D.B., R.J.v.O.), Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), the Netherlands; Division of Neurointervention (A.J.Y.), Texas Stroke Institute, Plano; Department of Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein; Department of Neurology (M.J.H.W.), Leiden University Medical Center; and Departments of Neurology (J.B.) and Radiology (G.J.L.à.N.), MC Haaglanden, the Hague, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
Commercial, Codman DePuy, travel expenses.
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
COdman Depuy, neurovascular, commercial
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Marieke J.H. Wermer, MD, PhD
From the Departments of Radiology (O.A.B., R.v.d.B., C.B.L.M.M.), Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.), and Anesthesiology (M.W.H.), Academic Medical Center, Amsterdam; Departments of Radiology (P.S.S.F., A.v.d.L.), Neurology (O.A.B., P.S.S.F., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam; Departments of Radiology (W.H.v.Z.) and Neurology (D.B., R.J.v.O.), Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), the Netherlands; Division of Neurointervention (A.J.Y.), Texas Stroke Institute, Plano; Department of Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein; Department of Neurology (M.J.H.W.), Leiden University Medical Center; and Departments of Neurology (J.B.) and Radiology (G.J.L.à.N.), MC Haaglanden, the Hague, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
ZonMw/NWO Veni grant 91612968
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
Netherlands Heart Foundation 2011T055
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Jelis Boiten, MD, PhD
From the Departments of Radiology (O.A.B., R.v.d.B., C.B.L.M.M.), Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.), and Anesthesiology (M.W.H.), Academic Medical Center, Amsterdam; Departments of Radiology (P.S.S.F., A.v.d.L.), Neurology (O.A.B., P.S.S.F., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam; Departments of Radiology (W.H.v.Z.) and Neurology (D.B., R.J.v.O.), Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), the Netherlands; Division of Neurointervention (A.J.Y.), Texas Stroke Institute, Plano; Department of Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein; Department of Neurology (M.J.H.W.), Leiden University Medical Center; and Departments of Neurology (J.B.) and Radiology (G.J.L.à.N.), MC Haaglanden, the Hague, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Geert J. Lycklama à Nijeholt, MD, PhD
From the Departments of Radiology (O.A.B., R.v.d.B., C.B.L.M.M.), Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.), and Anesthesiology (M.W.H.), Academic Medical Center, Amsterdam; Departments of Radiology (P.S.S.F., A.v.d.L.), Neurology (O.A.B., P.S.S.F., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam; Departments of Radiology (W.H.v.Z.) and Neurology (D.B., R.J.v.O.), Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), the Netherlands; Division of Neurointervention (A.J.Y.), Texas Stroke Institute, Plano; Department of Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein; Department of Neurology (M.J.H.W.), Leiden University Medical Center; and Departments of Neurology (J.B.) and Radiology (G.J.L.à.N.), MC Haaglanden, the Hague, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Paul J. Nederkoorn, MD, PhD
From the Departments of Radiology (O.A.B., R.v.d.B., C.B.L.M.M.), Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.), and Anesthesiology (M.W.H.), Academic Medical Center, Amsterdam; Departments of Radiology (P.S.S.F., A.v.d.L.), Neurology (O.A.B., P.S.S.F., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam; Departments of Radiology (W.H.v.Z.) and Neurology (D.B., R.J.v.O.), Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), the Netherlands; Division of Neurointervention (A.J.Y.), Texas Stroke Institute, Plano; Department of Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein; Department of Neurology (M.J.H.W.), Leiden University Medical Center; and Departments of Neurology (J.B.) and Radiology (G.J.L.à.N.), MC Haaglanden, the Hague, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Member editorial board Stroke-group Cochrane Collaboration since 2012.
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
Netherlands Organisation of Scientific Research: ZONMW 171002302, Preventive Antibiotics in Stroke Study, 2009- 2013.
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
Netherlands Heart Foundation (Hartstichting): 2009B095, Preventive Antibiotics in Stroke Study, 2009-2013.
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Markus W. Hollmann, MD, PhD
From the Departments of Radiology (O.A.B., R.v.d.B., C.B.L.M.M.), Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.), and Anesthesiology (M.W.H.), Academic Medical Center, Amsterdam; Departments of Radiology (P.S.S.F., A.v.d.L.), Neurology (O.A.B., P.S.S.F., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam; Departments of Radiology (W.H.v.Z.) and Neurology (D.B., R.J.v.O.), Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), the Netherlands; Division of Neurointervention (A.J.Y.), Texas Stroke Institute, Plano; Department of Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein; Department of Neurology (M.J.H.W.), Leiden University Medical Center; and Departments of Neurology (J.B.) and Radiology (G.J.L.à.N.), MC Haaglanden, the Hague, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
Eurocept BV ECHO
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
CSL Behring Eurocept Edwards
Editorial Boards:
1.
Section Editor Pharmacology Anesthesia & Analgesia Section Editor NTvA
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
Eurocept ECHO Edwards CSL Behring Boehringer
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
Eurocept Edwards CSL Behring
Research Support, Government Entities:
1.
ZonMW
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Wim H. van Zwam, MD, PhD
From the Departments of Radiology (O.A.B., R.v.d.B., C.B.L.M.M.), Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.), and Anesthesiology (M.W.H.), Academic Medical Center, Amsterdam; Departments of Radiology (P.S.S.F., A.v.d.L.), Neurology (O.A.B., P.S.S.F., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam; Departments of Radiology (W.H.v.Z.) and Neurology (D.B., R.J.v.O.), Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), the Netherlands; Division of Neurointervention (A.J.Y.), Texas Stroke Institute, Plano; Department of Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein; Department of Neurology (M.J.H.W.), Leiden University Medical Center; and Departments of Neurology (J.B.) and Radiology (G.J.L.à.N.), MC Haaglanden, the Hague, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
Payment to institution for consultancy activities for Stryker.
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
Unrestricted grants for the MRCLEAN trial were provided by: - AngioCare, Lamepro, Penumbra, Stryker, Medtronic/Covidien
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
Dutch Heart Foundation funded the MRCLEAN trial
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Aad van der Lugt, MD, PhD
From the Departments of Radiology (O.A.B., R.v.d.B., C.B.L.M.M.), Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.), and Anesthesiology (M.W.H.), Academic Medical Center, Amsterdam; Departments of Radiology (P.S.S.F., A.v.d.L.), Neurology (O.A.B., P.S.S.F., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam; Departments of Radiology (W.H.v.Z.) and Neurology (D.B., R.J.v.O.), Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), the Netherlands; Division of Neurointervention (A.J.Y.), Texas Stroke Institute, Plano; Department of Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein; Department of Neurology (M.J.H.W.), Leiden University Medical Center; and Departments of Neurology (J.B.) and Radiology (G.J.L.à.N.), MC Haaglanden, the Hague, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
GE Healthcare travel /speaker honoraria
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
My institution (Erasmus MC) has received unrestricted grants from AngioCare BV, Medtronic/Covidien/EV3?, MEDAC Gmbh/LAMEPRO, Penumbra Inc., Stryker?, and Top Medical/Concentric for the MR CLEAN study.
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
Dutch Heart Foundation
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Robert J. van Oostenbrugge, MD, PhD
From the Departments of Radiology (O.A.B., R.v.d.B., C.B.L.M.M.), Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.), and Anesthesiology (M.W.H.), Academic Medical Center, Amsterdam; Departments of Radiology (P.S.S.F., A.v.d.L.), Neurology (O.A.B., P.S.S.F., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam; Departments of Radiology (W.H.v.Z.) and Neurology (D.B., R.J.v.O.), Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), the Netherlands; Division of Neurointervention (A.J.Y.), Texas Stroke Institute, Plano; Department of Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein; Department of Neurology (M.J.H.W.), Leiden University Medical Center; and Departments of Neurology (J.B.) and Radiology (G.J.L.à.N.), MC Haaglanden, the Hague, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
DSMB of CoreValve Advance Study (MedTronic)
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Charles B.L.M. Majoie, MD, PhD
From the Departments of Radiology (O.A.B., R.v.d.B., C.B.L.M.M.), Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.), and Anesthesiology (M.W.H.), Academic Medical Center, Amsterdam; Departments of Radiology (P.S.S.F., A.v.d.L.), Neurology (O.A.B., P.S.S.F., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam; Departments of Radiology (W.H.v.Z.) and Neurology (D.B., R.J.v.O.), Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), the Netherlands; Division of Neurointervention (A.J.Y.), Texas Stroke Institute, Plano; Department of Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein; Department of Neurology (M.J.H.W.), Leiden University Medical Center; and Departments of Neurology (J.B.) and Radiology (G.J.L.à.N.), MC Haaglanden, the Hague, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
Stryker, payment for lectures to institution
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Diederik W.J. Dippel, MD, PhD
From the Departments of Radiology (O.A.B., R.v.d.B., C.B.L.M.M.), Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.), and Anesthesiology (M.W.H.), Academic Medical Center, Amsterdam; Departments of Radiology (P.S.S.F., A.v.d.L.), Neurology (O.A.B., P.S.S.F., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam; Departments of Radiology (W.H.v.Z.) and Neurology (D.B., R.J.v.O.), Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), the Netherlands; Division of Neurointervention (A.J.Y.), Texas Stroke Institute, Plano; Department of Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein; Department of Neurology (M.J.H.W.), Leiden University Medical Center; and Departments of Neurology (J.B.) and Radiology (G.J.L.à.N.), MC Haaglanden, the Hague, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Yvo B.W.E.M. Roos, MD, PhD
From the Departments of Radiology (O.A.B., R.v.d.B., C.B.L.M.M.), Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.), and Anesthesiology (M.W.H.), Academic Medical Center, Amsterdam; Departments of Radiology (P.S.S.F., A.v.d.L.), Neurology (O.A.B., P.S.S.F., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam; Departments of Radiology (W.H.v.Z.) and Neurology (D.B., R.J.v.O.), Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), the Netherlands; Division of Neurointervention (A.J.Y.), Texas Stroke Institute, Plano; Department of Neurology (W.J.S.), Sint Antonius Hospital, Nieuwegein; Department of Neurology (M.J.H.W.), Leiden University Medical Center; and Departments of Neurology (J.B.) and Radiology (G.J.L.à.N.), MC Haaglanden, the Hague, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
On behalf of the MR CLEAN investigators

Notes

Correspondence to Prof. Dr. Roos: [email protected]
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
*
These authors contributed equally to this work.
These authors contributed equally to this work.
Coinvestigators are listed on the Neurology® Web site at Neurology.org.

Author Contributions

Dr. Berkhemer: study concept and design, acquisition of data, analysis and interpretation, drafting of the manuscript. Dr. L.A. van den Berg: study concept and design, acquisition of data, analysis and interpretation, drafting of the manuscript. Dr. Fransen: acquisition of data, critical revision of the manuscript for important intellectual content. Dr. Beumer: acquisition of data, critical revision of the manuscript for important intellectual content. Dr. Yoo: acquisition of data, critical revision of the manuscript for important intellectual content. Dr. Lingsma: analysis and interpretation, critical revision of the manuscript for important intellectual content. Dr. Schonewille: acquisition of data, critical revision of the manuscript for important intellectual content. Dr. R. van den Berg: acquisition of data, critical revision of the manuscript for important intellectual content. Dr. Wermer: acquisition of data, critical revision of the manuscript for important intellectual content. Dr. Boiten: acquisition of data, critical revision of the manuscript for important intellectual content. Dr. Lycklama à Nijeholt: acquisition of data, critical revision of the manuscript for important intellectual content. Dr. Nederkoorn: critical revision of the manuscript for important intellectual content. Dr. Hollmann: critical revision of the manuscript for important intellectual content. Dr. van Zwam: study concept and design, acquisition of data, critical revision of the manuscript for important intellectual content. Dr. van der Lugt: study concept and design, acquisition of data, critical revision of the manuscript for important intellectual content. Dr. van Oostenbrugge: study concept and design, acquisition of data, critical revision of the manuscript for important intellectual content. Dr. Majoie: study concept and design, acquisition of data, critical revision of the manuscript for important intellectual content. Dr. Dippel: study concept and design, acquisition of data, analysis and interpretation, critical revision of the manuscript for important intellectual content, study supervision. Dr. Roos: study concept and design, acquisition of data, analysis and interpretation, critical revision of the manuscript for important intellectual content, study supervision.

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