CSC Dr. Bijoy Menon, University of CalgaryCSC Dr. Andrew Demchuk, University of CalgaryMR CLEAN-NO IV was a European multicenter RCT (Netherlands, Belgium, France) published in NEJM in November 2021.Question: Is direct EVT superior or non-inferior to IV alteplase + EVT in anterior circulation LVO stroke patients presenting directly to thrombectomy-capable centers?Design: PROBE design, 1:1 randomization, ~539 patientsKey Result: EVT alone was neither superior nor noninferior to intravenous alteplase followed by EVT with regard to disability outcome at 90 days after stroke. New England Journal of Medicine The incidence of symptomatic intracerebral hemorrhage was similar in the two groups. New England Journal of MedicineBottom line: Unlike the Asian trials (DIRECT-MT, DEVT) that showed non-inferiority for skipping tPA, MR CLEAN-NO IV couldn't confirm the same in European populations—so the bridging IVT + EVT paradigm remains standard for eligible patients at EVT-capable centers.

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