Corticosteroids for ischemic stroke (MARVEL trial)
Findings of reduced mortality and disability require replication
While outcomes from acute ischemic stroke due to large vessel occlusion in the anterior circulation have improved substantially in the era of thrombolytics and mechanical thrombectomy, overall outcomes remain poor.
Studies in animal models have suggested corticosteroids might reduce infarct size or extension of subsequent cerebral edema. When tested previously, steroids failed to show any improvement in outcomes after ischemic stroke, resulting in papers with confident titles like “Steroids have no role in stroke therapy.”
However, that was in the era before mechanical thrombectomy. Patients who have undergone thrombectomy for ischemic stroke may have substantively different cerebrovascular pathophysiology than stroke patients in the pre-thrombectomy era. Could steroids help them?
The MARVEL Trial
Investigators at 82 hospitals in China enrolled 1,680 patients with stroke and proximal intracranial large vessel occlusion presenting within 24 hours of symptom onset between 2022 and 2023.
A…
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