Methylprednisolone as Adjunctive to Endovascular Treatment for Acute Large Vessel Occlusion - MARVEL

Feb 21, 2024
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Author/Summarized by Author:
Anthony A. Bavry, MD, MPH, FACC
Trial Sponsor:
National Natural Science Foundation of China
Date Published:
02/08/2024
Date Updated:
02/21/2024
Original Posted Date:
02/21/2024
References

Contribution To Literature:

The MARVEL trial failed to show that methylprednisolone improves overall disability when used as an adjunct to endovascular thrombectomy.

Description:

The goal of the trial was to evaluate intravenous low-dose methylprednisolone compared with placebo among patients with acute ischemic stroke due to large vessel occlusion undergoing treatment with endovascular thrombectomy.

Study Design

  • Randomized
  • Parallel
  • Blinded
  • Placebo

Patients with acute ischemic stroke due to large vessel occlusion were randomized to low-dose methylprednisolone (n = 839) vs. placebo (n = 841). The dose of methylprednisolone was 2 mg/kg/day.

  • Total number of enrollees: 1,680
  • Duration of follow-up: 90 days
  • Mean patient age: 69 years
  • Percentage female: 43%
  • Percentage with diabetes: 20%

Inclusion criteria:

  • Acute ischemic stroke due to large vessel occlusion
  • Occlusion of intracranial internal carotid artery or first or second segment of the middle cerebral artery
  • Presenting within 24 hours of time last known to be well
  • National Institutes of Health Stroke Scale score ≥6

Principal Findings:

The primary outcome, disability level at 90 days measured by the modified Rankin Scale (score range 0 [no symptoms] to 6 [death]), was 3 in the methylprednisolone group vs. 3 in the placebo group (p = 0.17).

Secondary outcomes:

  • Mortality: 23.2% in the methylprednisolone group vs. 28.5% in the placebo group (p = 0.03)
  • Symptomatic intracranial hemorrhage: 8.6% in the methylprednisolone group vs. 11.7% in the placebo group (p = 0.04) 

Interpretation:

Among patients with acute ischemic stroke due to large vessel occlusion undergoing treatment with endovascular thrombectomy, methylprednisolone failed to reduce the overall degree of disability compared with placebo. The reduction in the secondary outcomes of mortality and symptomatic intracranial hemorrhage needs to be interpreted cautiously, especially since there was no difference in the primary outcome.

References:

MARVEL Trial Authors for the MARVEL Investigators. Methylprednisolone as Adjunct to Endovascular Thrombectomy for Large-Vessel Occlusion Stroke: The MARVEL Randomized Clinical Trial. JAMA 2024;Feb 8:[Epub ahead of print].

Editorial: Siegler JE, Prabhakaran S. Adjunctive Steroids as Stroke Reperfusion Strategy. JAMA 2024;Feb 8:[Epub ahead of print].

Clinical Topics: Vascular Medicine

Keywords: Ischemic Stroke, Methylprednisolone, Endovascular Procedures


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