Paper Chase 4 – Mr CLEAN the Stroke Machine

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Andrea W., M.D. -

You guys are awesome, and I'm a big enough nerd that I really like listening to paper chase. But I have a comment about the discussion this month . . . when discussing why the MR CLEAN trial may have showed a benefit while previous trials had not . . . there was discussion that "maybe the patients that got better with tPA just didn't get enrolled in MR CLEAN."
The NINDS trial was cited as the study that put tPA on the map. But I'd like to point out that even the NINDS investigators couldn't find an early benefit; hence there being a NINDS 1, a NINDS 2, and the 90 day outcome endpoint. So your comment about "if they're getting better with the tPA" doesn't mean that the patient is improving because of the tPA. It means that you just lysed a TIA. I agree that if the patient is improving that maybe they don't need to go for invasive therapy, and we certainly shouldn't be sending our TIA patients for intervention . . . . but the important point is that tPA has never shown an early benefit in any of the trials that claim to show a benefit. Thoughts?

Evan M., M.D. -

For those of us who have interventional neuroradiology, on which tPA stoke candidates do you think should get more advanced imaging (CTA Head and Neck +/- perfusion)? After these last three positive trials, our neuro-interventionalist are pushing for many, many more CTAs. I'm curious what is happening at other centers?

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