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MR CLEAN was the pivotal randomized trial that established the efficacy of intra-arterial treatment for acute ischemic stroke caused by proximal anterior-circulation arterial occlusion. Five hundred patients were randomized to usual care with or without intravenous alteplase plus intra-arterial treatment. The intervention group had a better overall distribution of functional outcomes at 90 days, with a clinically important increase in functional independence. There was no significant increase in mortality or symptomatic intracerebral haemorrhage. The trial was transformative because it showed that modern endovascular treatment using retrievable stents could improve patient outcomes when added to standard medical therapy. For HCPs, MR CLEAN also highlights the importance of patient selection and workflow: vascular imaging should identify eligible large-vessel occlusion quickly, and treatment should be delivered without unnecessary delay. The study provides the foundation for the larger evidence base that later extended thrombectomy into the late window and, more recently, into selected large-core strokes. Its relevance to IANCON's vascular neurology and thrombectomy sessions remains substantial.

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MR CLEAN was the pivotal randomized trial that established the efficacy of intra-arterial treatment for acute ischemic stroke caused by proximal anterior-circulation arterial occlusion. Five hundred patients were randomized to usual care with or without intravenous alteplase plus intra-arterial treatment. The intervention group had a better overall distribution of functional outcomes at 90 days, with a clinically important increase in functional independence. There was no significant increase in mortality or symptomatic intracerebral haemorrhage. The trial was transformative because it showed that modern endovascular treatment using retrievable stents could improve patient outcomes when added to standard medical therapy. For HCPs, MR CLEAN also highlights the importance of patient selection and workflow: vascular imaging should identify eligible large-vessel occlusion quickly, and treatment should be delivered without unnecessary delay. The study provides the foundation for the larger evidence base that later extended thrombectomy into the late window and, more recently, into selected large-core strokes. Its relevance to IANCON's vascular neurology and thrombectomy sessions remains substantial.
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