MARVEL (post-hoc analysis)
Trial question
What is the effect of adjunctive methylprednisolone in patients with AIS due to intracranial internal carotid artery occlusion undergoing endovascular thrombectomy?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
42.0% female
58.0% male
N = 579
579 patients (241 female, 338 male).
Inclusion criteria: patients with AIS due to intracranial internal carotid artery occlusion undergoing endovascular thrombectomy.
Key exclusion criteria: age < 18 years; pregnancy or lactation; mRS score ≥ 2; allergy to glucocorticoids; allergy to contrast agents; SBP > 185 mmHg or diastolic pressure > 110 mmHg; genetic or acquired bleeding constitution; bleeding history; chronic hemodialysis and severe renal insufficiency; life expectancy due to any advanced disease < 6 months.
Interventions
N=286 methylprednisolone (methylprednisolone 2 mg/kg IV daily, maximum dose of 160 mg, for 3 days).
N=293 placebo (matching intravenous placebo for 3 days).
Primary outcome
Percentage of patients achieving independent ambulation at day 90
53.2%
42.7%
53.2 %
39.9 %
26.6 %
13.3 %
0.0 %
Methylprednisolone
Placebo
Significant
increase ▲
NNT = 9
Significant increase in the percentage of patients achieving independent ambulation at day 90 (53.2% vs. 42.7%; RR 1.27, 95% CI 1.07 to 1.52).
Secondary outcomes
No significant difference in median mRS score at day 90 (3 points vs. 4 points; OR 1.14, 95% CI 0.98 to 1.32).
No significant difference in mRS score 0-2 at day 90 (37.7% vs. 30.7%; RR 1.24, 95% CI 0.98 to 1.56).
No significant difference in mRS score 0-1 at day 90 (19.7% vs. 19.8%; RR 1.02, 95% CI 0.73 to 1.42).
Safety outcomes
No significant differences in death, any radiologic ICH, gastrointestinal bleeding within 7 days after endovascular thrombectomy.
Significant differences in symptomatic ICH (9.4% vs. 15.5%), decompressive hemicraniectomy (5.6% vs. 9.9%), pneumonia (48.6% vs. 60.4%).
Conclusion
In patients with AIS due to intracranial internal carotid artery occlusion undergoing endovascular thrombectomy, methylprednisolone was superior to placebo with respect to the percentage of patients achieving independent ambulation at day 90.
Reference
Chong Zheng, Rongtong Li, Chaoxiong Shen et al. Methylprednisolone as Adjunct to Thrombectomy for Acute Intracranial Internal Carotid Artery Occlusion Stroke: Post Hoc Secondary Analysis of the MARVEL Randomized Clinical Trial. JAMA Netw Open. 2025 Feb 3;8(2):e2459945.
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